update to my previous post now on page 2 about " AF- either surgery or blood thinners " also triggers

Update

by TAC - 2022-03-21 20:18:11

If I read you correctly, you're not taking blood thinners at the present time, perhaps because your AF episodes are infrequent and short lived. However, your doctor has informed you that if the AF worsen, you will have to take blood thinners to ward off the risks of a stroke. You don't want to take them because you're afraid of havig bleeding complications. So, you are looking for ways to reduce the possibility of a stroke by alternative means. What your cardiologist told you is that sealing the LAA is a procedure allowed by Medicare, only to people who are already on blood thinners, and that for a very compelling reason can no longer take them. Finally, you said that you didn't have to see your heart doctor for another year. Well, it seems to that you're in great shape. If your doctor has allowed you not to take blood thinners for another year, that means that you're at a low risk for stroke, at least for now. Hopefully, the situation will remain the same and you will never have to take anticoagulants.

Medicare

by AgentX86 - 2022-03-21 21:04:41

The requirements for Medicare to pay for Watchman:

<https://www.watchman.com/content/dam/watchman/en-us-hcp/patient-selection-referrals/patient-pre-screening-tool/WATCHMAN_Pre-Screening_Checklist.pdf>

Private insurance companies are routinely paying for the Watchman device because it's cheaper than even Warfarin, by a long shot. Medicare is always behind the times. OTOH, Medicare doesn't pay for Warfarin or any other drugs for that matter. Medicare probably does pay for INR testing,  which is where all the money is. It doesn't have to make sense.

blood thinners

by new to pace.... - 2022-03-21 21:51:57

have been using a supplement that contains Turmeric 500mg..  Now taking 3 times a day.   Will also up the amount of "Hemp Seed Hearts" which i have been putting on my cereal in the morning which have both Omega 3 &6.  Will start using Hemp Seed oil on my salad.  Acpuncture for the heart.  Started today with that.

Have given myself a month to see if  what I have  been doing have lessen the  A-Fib episodes. According they have gone down from 184  Sept-Dec and 10 only  between  Dec-March.   Which to me is a lot.

new to pace

A-Fib, Anticoagulants, Etc.

by Marybird - 2022-03-21 22:50:01

New to Pace, it sounds as though your plans are to work on natural ways, diet, stress control, ie, avoidance of triggers, to keep the incidents of A-Fib at a minimum and short-lived, hopefully so as not to need the anticoagulant (blood thinners) or any LAA isolation procedures. To that I might add that I've been told that regular exercise, ie, moderate levels at around 150 minutes per week ( that could be a vigorous 30 minute walk 5 days per week but there are other options for exercise too) do a great job at keeping the AFib down. I think the exercise helps keep both my A-Fib at bay and my high blood pressure under control. In any case, I wish you the best going forward with all this. It sounds as though your cardiologist is on board with your plans, at least she is ok with your plans.

One of the advantages of your remote pacemaker monitoring reports is that your cardiogist can see how much and exactly when your A-Fib occurs, and if the incidents remain few and far between, you can all feel pretty good that your measures to keep it under control are working. They might ( probably would) contact you in the event something changed and you had a lot more A-Fib or other significant incidents where they thought a change in medication was indicated.

I guess the way remote pacer reports are handled varies in different medical practices. You mentioned that you received you received remote reports via your patient portal in December 2021 and March 2022, with an email to you with an alert for the March report. Do you normally receive all your remote report results via portal? There ought to be some sort of a summary interpretation of those results, though perhaps the comment you mentioned about the "current health trends show no abnormality" was that interpretative comment. I'm not sure what the email for your March report was all about if it didn't show anything new. It might be worth it to ask you pacemaker clinic/cardiologist just what their policies are regarding patient notification of pacemaker remote reports. 

In general, as I understand it, you can have abnormalities in a pacer report, but if they aren't new, and you are being treated for those issues, the office probably won't contact you about the report ( other than in a portal message if that is their policy). I never see any completed pacemaker reports from my cardiologist, though they have contacted me on three separate occasions when they got alerts, with instructions to increase my metoprolol and the third time to tell me of several longer episodes of AFib, and they started me on Eliquis then. I expect my pacemaker reports likely still show the intermittent runs of AFib, and possibly a longer run or two, but I don't expect them to notify me about them unless they wanted to change the medication or something. But I see them twice a year, plus an in-office pacer check, so they tell me what's going on then. 

It's true about Medicare ( and other insurances, from all indications) require a patient to at least have been taking anticoagulants, and have experienced problems ( most often bleeding) with the anticoagulants before they will approve a Watchman or other device. My sister had been scheduled for a Watchman ( she didn't get it because she died suddenly beforehand) and told me she had to go through an interview with a doctor appointed by Medicare before she was approved. She told me that Medicare won't approve a Watchman for a patient if the only reasons are that the patient doesn't want to take anticoagulants or says he/she can't afford them. My sister had taken Eliquis for a number of years, and had had serious bleeding ( a serious brain bleed from a fall on ice that left her with a fractured skull and traumatic brain injury. She had interstitial lung disease and was coughing up blood at times, they advised her to get off the Eliquis. 

Agent, far as I know, the Part D Medicare drug plans, and the Medicare Advantage plans that have drug coverage here still pay for anticoagulants, including warfarin, the NOACs, and anti-platelet medications. There has been some kerfluffle lately about the CVS Caremark prescription management programs cutting Eliquis out of their formularies, but that doesn't look to be the case for Medicare subscribers and most other people. Some of those formularies may not include Predaxa any longer, but I'd have to check about that. 

Medicare

by AgentX86 - 2022-03-21 23:19:58

If it's a drug included in an Advantage plan, it's not Medicare paying for it.  The Advantage plan is paying for it. Part-D is not part of Medicare, either. It's a separate insurance plan with the insurer.   Medicare doesn't cover drugs.

The CVS Caremark issue goes a lot deeper than Eliquis. Fortunately CVS Caremark cancelled the threat of taking Eliquis out of their formulary this year.  Us old farts put up a double-jointed-*it fit last year and CC dropped their plans.  They did take it out of many private/employer insurance plan's formulary this year. Next year?

That's only the tip of the iceberg as far as CVS Caremerk goes to screw us. Congress allows it (enables it, actually).

quarterly remote transmission

by new to pace.... - 2022-03-21 23:21:03

Thanks Marybird for your thoughtful commentary.

Unfortuantely for the quarterly transmission reports.  I wait a week hopeing the EP doctor reads it.  Than i have to call and ask for a copy.  This time i only got the summary page .  Which makes sense to me.

In all the time since Aug 2019 this was the first time an alert was recieved. Was give to the cardiologist then put in my patient portal.  I went up to the office to see what was going on.  Then asked for an appt to see her. Was told she was going to be out of the office for a week(children on school break).  Said i could see some one else or wait until she returned.  When i found out would be seeing her after her break.  Decided must be not a large problem.  Then relaxed.

I try my walking in the big box stores.  When it gets warmer will return to walking in my heated pool.  Did walk over to her office and back.  Short walk less then 10 minutes.

new to pace

Hope you get further clarification

by Gemita - 2022-03-22 08:23:34

New to Pace,

Thank you for the update.   U.S. guidelines on when to perform an LAA closure would appear to be similar to ours in the U.K.  Our National Institute for Health and Care Excellence states:

“Do not offer LAA closure as an alternative to anticoagulation unless anticoagulation is contraindicated or not tolerated”.

Regarding your last two quarterly report results, I cannot really understand your new comments which show only ?10 arrhythmia events for the last quarter and asking why was there a need for an alert?  Your last post clearly reported (see below) lots of atrial and ventricular tachycardia events:  hence the need for an alert and anticoagulation recommendation:-

18 NSVT events recorded as SVT-AF, with one NSVT episode at 240bpm 

740 AT/AF events over the last 3 months - max duration on 3/1/2022 of 3.2 hours.

March 9th 5 VT episodes, max duration 20 beats at Ventricular rate of 188 bpm.  

The above findings (over 3 months) would cause me and my doctors some concern, particularly as you are not on anticoagulation or rate control meds.  

Has there been a misunderstanding between you and your cardiologist, or a mix up in the reporting, I wonder?  I recall they initially mentioned that your Reveal Linq (which you haven’t got) alerted them about your tachycardia episodes.  Did you query this error?  Are they really talking about you new to pace or someone else?

I note you are not due to see your cardiologist for a year, so I presume you have not been started on any medication for your arrhythmias?  I am now beginning to wonder if the 184 AF episodes reported in the December 2021 quarterly report was not your report either, unless they were very short in and out episodes?  Clearly longer episodes of AF could indicate that your AF is becoming more persistent.

The comment regarding both quarterly reports stating "health trends do not demonstrate significant abnormality”  would also suggest to me that they are not concerned about any serious health conditions/arrhythmias present.  AF is certainly not regarded as a dangerous arrhythmia especially if the heart rate is well controlled and anticoagulation is given when required, based on any risk factors.

I am glad you are doing all you can to try to stop your AF and to find an alternative to anticoagulation and other AF meds to control heart rate.  Of course the evidence is that even infrequent short runs of AF could put us at risk of an AF related stroke, so I hope you are able to find an effective treatment, but if anyone can succeed, it is you new to pace.  In the meantime, I would get clarification on whether the tachyarrhythmias highlighted above were really yours?

a fib errors?

by new to pace.... - 2022-03-22 09:42:34

thanks Geminta for your thoughtful comments. The nurse said she mentioned Reveal Linq in error.  Did send a note  to the cardiologist to ask that question  and  asking them to send a copy of results of this last visit to my GP.

I have been looking at other triggers and how to avoid them.  Of course the common one is Stress. 

I suspected some foods might be a problem.  This morning found out  that foods  containing  Tyramine can cause  fast heart beats. .   Fermented foods: my go to  is Saukeraut.. An i just pruchased a couple of jars.   Had cut back on the corned beef because of the high salt. Indulged but had found a substitue used artichoke quarters with saukeraut/swiss cheese/ryebread/ thousand island dressing. Or grouper .  Guess those types of sandwhiches are now out.  As  saukeraut is out now.  Aged cheeses, processed foods(never eat), citrus.  Could me why my episodes had lowered this past quarter. As had started to cut back on the above sandwhich.  Tried not to eat soy, then found out in Mayo.  Found a Vegenaise to use instead.

new to pace

Triggers for AF

by Gemita - 2022-03-22 13:35:01

Absolutely New to Pace, food is my No.1 trigger for an episode.  In fact if I have tyramine rich foods like mature cheeses or drink red wine, it guarantees an episode!  I never eat foods like ham, sausages, smoked fish, sauerkraut.  I think we can start a whole new chapter/thread on the subject of AF triggers though, because there are so many triggers like anxiety/stress, food triggers, dehydration, lack of quality sleep, high blood pressure, too much caffeine or alcohol, being too hot or too cold, exercising too hard and of course many health conditions like a thyroid condition and so the list goes on.  To keep us free from AF with food restrictions and lifestyle changes alone would require a fairly restrictive lifestyle which is why I still take my low dose beta blocker which I feel does no harm and holds back my episodes.

Surprised you eat corned beef.  Not only high in salt, but the wrong kind of fat.  Maybe it is because it was a war time staple?  I know Michael is crazy about corned beef - threatens to open a tin when I am not around and I have threatened to donate the corned beef to the local food bank.

I will be interested to hear any further news about your arrhythmia control and stroke prevention and whether those reported arrhythmias, highlighted in my post above, were really yours?  Take good care