NICE: Atrial Fibrillation Management

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NICE guidelines CG180 August 2014 requires GP’s offer people with atrial fibrillation a personalised package of care. The package should be documented and delivered and cover stroke awareness, rate control, rhythm control, contacts for advice, psychological support, anti coagulation and support networks. Is it just me or did I fall through the gap?

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  • Posted

    No I am certain it's not just you.

    My wife was diagnosed with AFIB, almost 12 months ago now, and she still has been given minimal information.

    The only contact she has are her Blood Test appointments and those people can't tell her anything. She is louth to make a GP appointment to take up time and any information is obtained "online"

    GP Surgery including practice nurses have a completely blasai attitude.

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    • Posted

      Hi George, Having got a chest infection resulting in pneumonia I was given some antibiotics, which sorted the bug, but I was still out of breath cycling to work. I returned to GP who checked blood pressure, took blood, etc. but it took sometime, including a hospital visit, before someone actually checked my pulse and bingo I had AF. I was then left in limbo i.e. what happens next? I went private in the end and saw a consultant cardioligist and had a cardioversion.
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  • Posted

    I must have fell through also. Do u live in US?
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    • Posted

      Hi, I am interested too, I was diagnosed a year ago, had one chat with the GP, I have INR test every couple of months. Had a heart scan, waited six months for the result. The cardiologist who read the scan sent a letter to the GP saying that I needed to be anticoagulated, but that he didnt feel it necessary to see me. I received a copy of this letter when I rang the hospital about my results, but apart from that have had no contact with anyone. 
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    • Posted

      Hi Pauline, sorry to hear that it took so long to go on anticoagulants which I assume is warfarin. Newer types of anticoagulants are also now available and are becoming increasingly common with no routine INR tests. These include:

      apixaban (Eliquis) 

      dabigatran (Pradaxa) 

      rivaroxaban (Xarelto) 

      ​I am on rivaroxaban but maybe you should see another GP!

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  • Posted

    I also fell through and know many people who have never seen cardiolist or an anticolgulant nurse just given meds by GP and apart from regular INR no other contact. NICE and NHS England brought out new guidlines recently you may be able to find them on NHS web site if not I will endeavour to get it together and let you all know.

    L.

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  • Posted

    I presume you are from the US. Comprehensive guidelines which may be difficult to observe even in the US.

    I am from Malaysia and depend on my cardiologist and 'self-help'. I can imagine the tens of thousands who only depend on their family doctors or who cannot afford/have no access to health care.

    People like us got to thank Google and the internet for enabling us to seek alternative opinions.

    Many thanks for sharing.

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    • Posted

      Hi Siaw, No I am UK based not the US although I did live in Malaysia (Miri Sarawak) for ten plus fantastic years. Agree with you on those who cannot afford or have limited medical access but I also believe in a number of cases there is a communication breakdown between first line medical care (GP's) and specialist medical care (cardiologists, electrophysioligists).

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  • Posted

    Hi everyone,

    The information I gleaned was an article in the Daily Telegraph that says more or less what Drupe has already said with one difference they are now going to include AF in the target payment scheme that is already used for many other LTCC. there is a thing called QAF (quality assurance framework)  GP's have to meet QAF targets every year on lots of conditions like asthma diabetes etc and AF is to be included, if you want to read the article you can go to  telegraph.co.uk  the article is on page 6 of the daily telegraph Tuesday 2 Aug.

    L.

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    • Posted

      thanks for that Alan,

      But as it says in the article it was deferred from 2015 to 1st April 2016 which is why those of us diagnosed before that date were not being offered it by our GP's hopefully it will now happen as long as it is not only offered to newly diagnosed after that date, we will wait and see.

      Thanks again

      Linda.

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    • Posted

      Hi Linda & Alan, thanks for this I was'nt aware of these indicators albeit they only apply to England and were only adopted on the 1st April 2016. Dos this mean that the CHADS2 scoring system is now replaced by the CHA2DS2-VASc scoring system? I ask because I have a CHA2DS2-VASc of 2 and under the CHADS2 it may have been 1. I am now busy reading the NICE Quality Standard QS93.

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