Crtd

Discharged

by AgentX86 - 2021-11-18 20:30:20

I was discharged from my EP.  As long as everything is ticking, he saw no reason to go back to him on a scheduled basis.  My cardiologist willl take over the routine maintenance (the device clinic is in his office anyway).  I see him every three months, give or take, anyway.

CRT-D follow up

by Gemita - 2021-11-19 05:33:46

Lackawanna48, Thank you for your post and concern for another member with a CRT-D who has been discharged from the care of his cardiologist.  I am assuming this is because his condition has stabilised with the treatment he has received.  He still remains under the care of the device clinic who will carry out routine in person device checks and remote transmissions to monitor his condition and these should still be reported to healthcare professionals for follow up if required.

Routine health care is managed by a general practitioner (GP) here in the UK, like in many other countries.   We see our GP for follow up periodically if we have a chronic health condition like heart disease.  I feel though that heart failure needs specialist care, monitoring and follow up for the patient to do really well.  In my experience since Covid, follow up care in the community for a heart failure patient can be inadequate and the debilitated patient may struggle to be seen by their GP, to receive important investigations, or to stay under the care of a specialist team.  Without good support from caring health professionals and family members, debilitated heart failure patients will suffer.   Although we are still fortunate to have a free health service when it runs well, many patients are slipping through the net now and not receiving the timely care they need.

Despite my above comments, like AgentX86 says, once a patient has been stabilised by their EP and the arrhythmia or electrical condition has been treated (with a pacemaker, medication or surgical procedure), there is little for the EP to do routinely except to get the device clinic to actively monitor for any changes in our condition, particularly if patients report any new or worsening symptoms.  I am now seeing my EP less often since my pacemaker is working so well for me.

I hope you are happy with your care and will remain safe.

CRT-D Followup

by AgentX86 - 2021-11-19 20:21:10

I completely agree, Gemita.  I know little of the UK healthcare system but I can't imagine anyone with HF being put in the care of a GP.  It's also not something in the EPs bailiwick either.

Being more of a structural issue the followup should be done by a cardiologist, IMO.  My cardiologist is an "interventional cardiologist".  These specialized cardiologists implant pacemakers in people in HF but may not have electrical problems.  They do heart caths and stenting so a PM isn't a long jump.  I don't know if such a specialty exists in the UK but it seems to be a good idea.

CRT-D follow up

by Gemita - 2021-11-20 07:58:11

Hi AgentX86,

Yes my EP is both an excellent EP and a good interventional cardiologist.  I think many of them are in my London Hospital.  Also in my husband's London hospital where he had his stents placed by his Cardiologist, both EP and cardiology specialities overlap since electrical disturbances often don't occur in isolation and are frequently seen with heart disease/heart failure patients.  

I find it strange that the member who has been discharged has not been informed of a care plan.  I hope in the very least he receives a clinic letter explaining the outcome of his consultation with the assistant cardiologist and what steps he should follow in the event of worsening symptoms.  A copy of any letter would hopefully go to his GP too so that they will be kept firmly in the picture.  In my opinion, a most unsatisfactory outcome and lack of common courtesy 

EPs, Other Cardiologists and GPs.

by Marybird - 2021-11-20 13:09:50

Just reading all the comments in this, and in the other thread about who's taking care of whom for what, cardiac wise. I don't have extensive experience with EPs,  I was referred to one ( at my request) by the interventional cardiologist I had been seeing, this EP diagnosed my SSS, implanted the pacemaker, characterized the tachycardia, and prescribed medication, not just for the tachy but my hard to control high blood pressure as well. I don't have any structural heart issues or coronary artery disease, so it looked as though this EP would continue managing my pacemaker, arrhythmias and high blood pressure and the interventional cardiologist kinda stepped aside, remaining in a " PRN" category for me. But both this EP and the one they hired to replace him left the practice, and the interventional cardiologist I had been seeing stepped back in to manage both my pacemaker and other issues.

The practice set up some sort of liason with a group of EPs to see their patients who have issues needing to be addressed by EPs, ablations, etc., but these patients' continuing management is done by their referring interventional cardiologists. So I don't have an EP either, but the interventional cardiologist and his team ( including his PA and the tech in their pacing clinic, both exemplary professionals as I can see) have done a good job of finding, tracking, and managing my issues. 

I'm thinking part of the issue with EPs is their relative rarity, we just don't see all that many of them, couple that with the ever increasing numbers of people with cardiac electrical issues, implanted cardiac devicesand so on, I'd think that makes the EPs workloads almost impossible to keep up with. So when it's determined that a patient is no longer in (at least urgent) need of an EP's services, they may be shuttled off to another medical provider who can manage the patient's issues and the EP maybe relegated to a consultational ( or occasional referral as needed ) role. I'm not familiar with the way the NHS works, but in formally discharging a patient from an EPs service to that of an interventional/general cardiologist, or even a GP, and maintaining a relationship with a pacemaker/ICD clinic, seems to be the way things are done these days. While they are all important, I'd almost see the device clinic liason as the most important to the patient, as that is where the actual monitoring is done, and referrals made to the appropriate provider depending on the findings. The other issue, of course, would be that if the GP is relegated to the primary gatekeeper and "watchperson" for the patient's cardiac issues ( along with everything else), it's vital that this doc be knowledgeable about those issues so he/she knows what's important, what needs urgent attention and what could wait a bit. I suspect that might be a problem sometimes.