Brendan

Age at interview: 59

Age at diagnosis: 57

Brief Outline: Brendan realises that he had mild symptoms of AF for years, but it was only at a routine blood pressure check that AF was discovered. He has had 3 cardioversions but is now in permanent AF. He takes warfarin and digoxin and feels in ‘quite good health’.

Background: Brendan works full time in a senior role within social care. He is married with 4 grown up children. Ethnic background: White.

More about me...

Looking back, Brendan remembers having occasional palpitations and noticing an irregular heartbeat for a number of years, particularly after exercising, but assumed that his GP would pick anything serious up. He was active and his symptoms did not interfere with his life, so he put them to the back of his mind. He has since found out that a number of relatives have or have had some form of heart condition or irregular heartbeat, including Wolff-Parkinson-White syndrome, and wonders whether there is a genetic element to AF.

A couple of years ago, Brendan had his blood pressure taken when joining a gym. He was told that his blood pressure was high, and he saw his GP and was prescribed medication. During a later routine check-up, Brendan’s GP noticed that he had an irregular heartbeat, and after conducting an ECG, referred him to a cardiologist for a further ECG and ultrasound. Brendan was surprised when he was admitted to hospital for tests (feeling it was a little alarmist), but he was diagnosed with atrial fibrillation and prescribed a beta-blocker, and warfarin to reduce his risk of stroke. He found receiving an official diagnosis of AF came as a shock and it was ‘sobering’ to be told his heart was not operating perfectly. 

Brendan has had three cardioversions as day procedures – with the first two his heart went back to normal sinus rhythm for a short while before returning to AF, and with the third his heart reverted from normal sinus rhythm back to AF almost immediately. He felt pleased when the cardioversions worked, but disappointed when his heart went back into AF. He discussed the possibility of a catheter ablation with his cardiologist, but since his symptoms do not impact greatly upon his life, they decided that he would stay in permanent AF and be treated accordingly. Brendan now takes warfarin and digoxin. He is aware of an almost constant fluttering feeling in his chest, which at times feels more ‘bouncy.’ He never feels short of breath, and continues to exercise and eats healthily. He feels a little more tired than he used to, but is not sure whether this is due to AF or his age. Brendan also has arthritis, and finds that this limits him much more than AF does. 

Brendan has a finger prick blood test every 4-6 weeks at his GP surgery, to monitor his warfarin levels. His INR is generally stable. Brendan sees his cardiologist every six months for a check-up, and is very pleased with the care he has received. He feels that the cardiologist has communicated well with him and Brendan has participated positively in discussions about his care. As a result, Brendan says he has confidence in his cardiologist. Brendan is aware that his AF may get worse in the future, but feels pleased to have had good health up to this point.  

Brendan says he was amazed to find out how common AF is, even though he had never heard of it. He notes however that people are generally aware of high blood pressure and cholesterol. He feels that raising awareness of AF would be beneficial, if done in a way that does not alarm people or discourage them from addressing their symptoms. Brendan’s travel insurance premium has risen a little after declaring he is being treated for AF. He feels that people may often be reluctant to see their GP about health conditions if they feel it could affect some other area of their life in the future, such as employment or insurance for example. On reflection, Brendan feels he should have seen his GP sooner, as earlier diagnosis and treatment may have prevented his AF from developing into permanent AF. 

Brendan feels that patient involvement in decision-making is vitally important, and that a medical professional should listen, provide information about the condition, and give patients an idea of their prognosis. He advises people with AF not to panic, to keep themselves informed about AF and to keep active. Brendan used the internet extensively when he was diagnosed to research AF, and receives the newsletter from the Atrial Fibrillation Association. Brendan says that his family were concerned when he was diagnosed, but are now reassured as he is being treated and AF is not restricting his life.  

Interview held 19.9.12

Brendan suspected that something was wrong for ‘a very long time’. He was not diagnosed until his doctor noticed an irregular heartbeat when taking his blood pressure.

I actually only discovered that I had AF about a year ago and that was really because I was attending the GP as a result of what I thought was high blood pressure. And in taking my blood pressure he noted that I had a very irregular heartbeat, and then he did an ECG himself and then referred me to hospital to have an ECG. And that’s basically how I found out about it. I suspect, however, I mean I know, however, that I’ve, you know, that there was always something sort of odd. I’ve known that for years and years. I suspect I’ve probably had AF for a very long time. I’m, noted, you know, I would I was aware, for example, that my own heartbeat would be irregular on occasions but I always assumed that a, if it was serious enough, my GP would pick it up. 

Brendan found a formal diagnosis sobering and had questions about how this could impact in the longer term.

I suppose I found a formal diagnosis, I hadn’t been terribly familiar with atrial fibrillation before, with what it was. I’d heard used words, you know, term, you know, like irregularities, which are much less threatening sounding. So to have a formal diagnosis of AF was quite sobering. And I wasn’t sure either whether, you know, again, I wasn’t quite sure just well, how serious is that, what does that mean in the greater scheme of things? Does that mean you can continue leading a normal life or does that mean something, you know, could be health threatening, you know, in the longer term? So that was very sobering, as I say. I found the consultant extremely positive about it. I thought he was very, very good and very confident about trying, you know, whatever could be tried. And that really was the first sort of, I mean I’d read about atrial fibrillation and I sort of I spoke to people about it and it just, you know, was came to terms with that fairly quickly.

Brendan has had little difficulty adjusting to warfarin. He explained the purpose of anticoagulants.

Well, I mean basically, in the, as I understand it and my science may be a bit wrong [laughs] but because of the fibrillation, the aorta does not necessarily empty itself of all of it, so there’s a possibility there might be an occurrence there might be a danger of a clot forming. So in order to prevent that, the blood is kept at a thinner level, which is what the warfarin does, and it’s between an INR of two and three I think is my, is the range that I have to stay within. I probably had been aware of warfarin before in the sense that one of my friends experienced AF, and she had resisted warfarin for a long time but, eventually, agreed to go on it. So I knew kind of what it was about, and I’m very lucky in the sense that I didn’t have any difficulty in adjusting to it either.

Brendan had discussed the newer anticoagulants with his doctor but was happy to stay on warfarin.

I can’t remember the name of the drug but I mean I think there’s been a fairly recent breakthrough. Which I have, I mean I discussed with the consultant, not sure whether it was last time or the time before that the consultant, I discussed it with him. At that stage, we thought since the warfarin since I have no problem with warfarin, since it’s relatively stable, that it might be better just to stay with warfarin. And I haven’t really thought about it since then, you know. I haven’t really worried about it since then but it’s something I’d keep under review.

For Brendan, good professionals listen, provide information and instil confidence in their patients.

I think the first thing would be good information, without a shadow of a doubt, I think good information about what’s happening to you. I think an honest dialogue as well with your whoever’s, you know, with the clinicians involved about what it means, what the options are, and probably some consideration about prognosis and things like that, you know, what it is you can expect. I think those for me would be the key things. Very much I think a mark of any clinician is their ability to listen as well as to inform.

I think about AF, about anything else, as I said earlier on, what makes a good professional is that, you know, I think timely information, well-articulated information. The ability to listen as well to what’s being said and to get into real communication with your patient is very, very important. I’m very lucky because I have had, particularly my consultant has demonstrated all of that, which means that I have a huge amount of confidence in him. Now no patient is going to respond well to any clinician unless you have confidence in what it is they are saying. And I think that’s something that clinicians are very, very slow to learn. I mean I’ve seen it again and again, you know, they just don’t listen. So that, I think that for me would be a really, really important message.