why no stents?

[Dorisgate]

Over the weekend my dad had a major heart attack and was told the arteries on the side of his heart have been blocked for some time, with the right side compensating. He was given an emergency angiogram but they didn’t insert any stents - they said he’d need up to 5. My initial thoughts were that they were considering bypass surgery but we’ve now been told he might be discharged with beta blockers and medication to manage his condition. Surely without any stents he’s high risk of another heart attack? My dad is in the early stages of dementia and I feel like the medical team simply want to leave him to die 😢

[DWizza]

Blimey that’s tough. I think you’ll need to reach out to the consultants ( via secretary ?) to find out why. Has he received his discharge notes ? Maybe they think the surgery would be too much of a risk based on other factors ? I hope you get answers soonest.

[Dorisgate in reply to DWizza]

Thanks for responding. Dad is still in hospital at the moment so no clear next steps have been decided yet. I appreciate your thoughts 😘

[Lowerfield_no_more]

+1 on reading through his discharge notes. As your father is in the early stages of dementia has anyone taken over through power of attorney for health and welfare to look after his interests. If not it is worth considering, although if there is not one set up yet that might not be possible depending on how far his dementia has progressed.

[Dorisgate in reply to Lowerfield_no_more]

We have power of attorney for him - the consultant still insists on trying to explain things to my dad when there’s no other family member present. It’s very frustrating! 😘

[Agoodwalkspoiled]

So sorry for you and your family at a very difficult time.

After carrying out my angiogram my consultant gave me the choice there and then for continuing with an angioplasty. The whole procedure took over 5 hours for 3 stents to be inserted. There were a lot of complications in a very difficult procedure and I’m glad I had a choice but it is not always the right route for everyone.

[Dorisgate in reply to Agoodwalkspoiled]

Thank you. 5 hours is a long operation. I thought inserting stents was fairly straightforward so knowing it isn’t might explain their reservations. Thank you for sharing your experience 😘

[Mooney1963 in reply to Dorisgate]

It’s not straight forward at all I had a cardiac arrest during my angiogram

[Daffodilpuss]

Could it be that they're considering giving him medication temporarily while they decide what's the best thing to do, ie stents or a bypass? I do think your family has a right to know so hopefully you can get an answer about this from the consultant involved. I must say it would seem very odd not to do either of the procedures mentioned and just leave him on meds . I hope you get some answers.

[Blearyeyed in reply to Daffodilpuss]

You do need to ask to speak to his Consultant about all these questions.Surgery and Post surgery can be complicated for people with Dementia and they may need more specialized care to help them cope with recovery that requires organising.

They should really be explaining everything to you as his next of kin and asking your opinion as his medical advocate, even if you haven't got a POA .

This is particularly true if your father has Dementia and has had an on ward Competency test to see if he's able to understand and make decisions about his own care.

[Dorisgate in reply to Blearyeyed]

Thanks both of you. We have Power of Attorney for my dad but they still insist on talking to him without a family member present. I did call the BHF helpline today and the nurse did mention that general anaesthetic can have an adverse affect on people with dementia. I appreciate you both responding 😘

[Blearyeyed in reply to Dorisgate]

If you have POA , you may need to request to speak to the most Senior doctor involved, politely and firmly remind them of the fact , tell them that in future any information about your father needs to be discussed with you first , and any decisions about care must be agreed with you. Then point out that you would not wish to need to complain to the Chief Executive Office about them not communicating with you but you will have no choice but to do so if they continue to insist on talking to your father and not you.It's a gentle threat but no doctor wants a complaint made about them to the Chief Exec.

If you have the same issue with the GP surgery , have the same conversation but point out that you would have to complain to the local Integrated Care Board.

[Dorisgate in reply to Blearyeyed]

Thanks for the advice!

[Dorsetjohn]

Do you have the health and welfare POA or just the financial affairs?

[mozart27]

Please search "SENIOR-RITA trial", the results of which were published last year: "These results provide a foundation for older patients with NSTEMI and their clinicians to make an informed decision about whether or not to undergo invasive management". Conservative treatment with just medication may well be best.

[Milkfairy Heart Star in reply to mozart27]

The Principal Investigator of SENIOR RITA trial is the first woman, professor of Interventional Cardiology in the UK and a champion of women heart patients too.

bhfcrc.org/senior-rita-tria...

[mozart27 in reply to Milkfairy]

Yes, she is a highly distinguished Interventional Cardiologist and I think the results of the trial that invasive management in the elderly wasn't more effective than conservative treatment came as a surprise to her

[Milkfairy Heart Star in reply to mozart27]

There was another important finding.

If a person did have invasive management, it reduced the risk of having another heart attack and number of hospital admissions.

This potentially would improve the quality of life for many older patients, as any hospital admission for an older adult can impact on their physical and mental being.

bhf.org.uk/what-we-do/news-...

[mozart27 in reply to Milkfairy]

Yes; I think they were less confident about this finding but thanks for pointing it out. I am 75 this year. My father died at 65. He had a heart attack and then a second one two or three months later which, sadly, killed him. Fortunately, I have never had a heart attack although I take medication for hypertension and also a statin. For a variety of reasons, informed in part by SENIOR RITA, I have decided not to have invasive management if I did have a heart attack and have made an Advance Directive and RESPECT form to this effect.