My husband had a very big heart attack almost 3 years ago. He is under the care of Professor Cowie at the Royal Brompton hospital (on the NHS) and now also has an ICD fitted. Professor Cowie said right at the beginning that my husband needs Candesartan to improve the heart muscle and increase life expectancy, and he explained that he would start on a low dose that would be very gradually increased, gauging my husband’s blood pressure, which tends to be quite low, and how he copes with the drug. The dose has been increased three times with no problems, and his blood pressure has remained constant. Two weeks ago Professor Cowie suggested increasing the dose again during an online consultation, and he wrote to our G.P. as he has done frequently in the last 3 years, to explain what is happening and suggest the drug changes.
Our G.P had not seen or spoken to my husband since his heart attack until yesterday, when he rang to say he would not prescribe the increased dose of Candesartan. He stated that my husband’s blood pressure is too low. My husband explained that Professor Cowie knows his blood pressure is low, that in fact it has not changed significantly since his heart attack, and that on balance professor Cowie believes the Candesartan is necessary and that his body will cope with the increase, but the G.P still refused. The G.P also refused to prescribe vitamin D suggested by Professor Cowie, stating that my husband should buy it if he needs it. Professor Cowie had suggested it as a precaution stating that several patients were presenting with low vitamin D since Covid 19 and it’s a simple thing to do. The phone call with the G.P lasted about a minute.
We are at a loss to either understand this or know what to do. Professor Cowie spends a lot of time with patients and is very thorough. He looks carefully at blood test results, blood pressure, ECGs etc and asks a lot of questions. He explains drug changes and what might happen very clearly and obviously knows what he is doing. He is a renowned heart specialist. It makes no sense to us that our G.P now thinks he knows better when he has never even seen my husband (literally we didn’t even know his name when he called). The blood pressure readings are those taken regularly by us and reviewed by Prof Cowie. The blood test results are all good (kidneys, liver etc all normal function).
Does anyone have any suggestions or ideas about what we can do? We have an email address for Professor Cowie but we’re not sure what he can or will do if the G.P digs his heels in. We have been hoping that the Candesartan will make a difference and the long term plan has always been to increase the dose as much as possible. It feels like the rug has been pulled from under us.
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My GP’s the same, I really struggle to get them to prescribe anything, due to cost. You could ask to speak to the practice manager and ask them to try to resolve the situation as it’s a recommended treatment from a specialist, however, if the GP is a practice partner I can’t see the practice manager overruling them.
I would also email Prof Cowie to make him aware of the standoff with the GP.
I would certainly let the Professor know about this. There is no point in seeing an expert if the GP is going to undermine him. If he doesn't agree with the Professor then he should contact him to sort it out, not just refuse to accept his opinion and suggestions for treatment.
There isn’t much of a contest is there, one medic is a “specialist” in cardiac issues the other is a “general practitioner”. I know who I would be listening too as are you. I would indeed email your consultant and if no joy arises from it then I would change my GP.
Are there other GPs in your practice, I imagine there are and if you can’t get any joy with another one then I would change my GP practice as a priority. I have never known my GP refuse what a specialist has recommended,
Why on earth do we have specialists if a random GP is going to ignore their advice, it sounds like arrogance to me and that helps no one.
Your husband is dealing with his heart not a pain in his little finger or something insignificant and deserves the very best treatment available. Keep fighting and all power to you.
My husband has the exact same issue with his GP & candesartan. The cardiologist, who is a heart failure specialist, wanted the candesartan increased to as high a dose as possible. GP wouldn't do this as she was concerned about blood pressure, BP is always on the low side but well within range. We were presenting her with BP readings on a regular basis & It took almost a year to persuade her to gradually increase it, at no time did the increase affect his BP. Unfortunately, it did seriously increase his potassium level, so he was taken off the candesartan. After a month my husband was put back on 2 mg (previously it was 8mg then 16 mg) & GP won't increase it again nor will she change it to another med.
I rang the HF nurses for advice and was told, yes, a gp can override a consultant if the GP feels it would detrimental to the patients health at that time. All you can do is keep asking.
We have a consultation with the cardiologist in a few weeks so will mention it then.
Sometimes the problem is with the local Care Commissioners who decide how money is to be allocated so the Vit D is probably not allowed - I should be prescribed antihistamines for my asthma and allergies but have to pay myself now.
I have had a GP refuse to prescribe Bisoprolol but that is because she was familiar with my asthma history and didn’t think it was safe (covering her back). I was happy to take the alternative suggested by the cardiologist and when in A&E with AF and a bad cough the docs there said I shouldn’t take Bisoprolol unless started in hospital to monitor my reaction.
I can’t see any excuse in your case and I believe the action to take if all else fails is to contact your local PALS to liaise on your behalf.
Email your GP as well and keep your archive your copy. You should be able to slowly build a case that may persuade your GP to concentrate a bit harder.
I take it your husband is on 16mg Candesartan ?? it doubles as it is increased so you may start on 2mg then 4 then 8 then 16 then 32mg ( or any combination ) I was just going up to 32mg when Candesartan was stopped so I could switch to Entresto.
I am just grateful I have a GP who is at the top of her game she discusses everything she receives from either the Consultant or the Heart Nurse, to make sure we both understand what is going on !!
Because I have two different Cardiologists there was a cross over with medication between the two. I know my GP wrote to both Consultants and asked did they not read each others letters to her, and me the patient. It has never happened again !!
One other point I have received Prescriptions direct from the Cardiologist and Heart Failure Nurse who then write or phone to GP practice with the changes, so maybe the GP is waiting for either to issue !!
When I was prescribed Asprin I told my GP I would just buy them in Tesco she wouldn't hear of it. When I said I would pay she just said it is a Medication Prescribed for You the NHS will pay.
Yes he is currently on 16 mg and was due to go up to 32 mg. The GP is aware that he has been asked to prescribe it. Changes in medication ( which are quite frequent) have always been managed by the consultant writing to the GP. The GP has simply dug his heels in this time and yet is not interested enough to spend any time talking to my husband. He is completely dismissive. We are now waiting to see what the cardiologist suggests but will also email the GP as suggested. Unfortunately, emails to the GP seem to go to a general reception address but at least it will provide a record we can refer back to.
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