David Y

Age at interview: 67

Age at diagnosis: 64

Brief Outline:

David was diagnosed with atrial flutter and later developed atrial fibrillation. He has had two cardioversions and a cardio ablation. He currently takes aspirin (but will shortly return to warfarin), plus atorvastatin, bisoprolol, and an ace inhibitor.

Background:

David is a civil engineer and works as a delivery and compliance manager within the communications industry. He lives with his wife and has two grown-up children. Ethnic background/nationality: White British.

More about me...

David has always been active and involved in sport. One day at the gym, someone took his pulse and it was 140 beats per minute, and it stayed this way even when resting. David says he did not really have any symptoms, apart from light palpitations. He did also have headaches and a stiff neck. He remembers that five years before, he had some spells of dizziness, blurred vision and slurred speech, but never told anyone. Doctors think that these may have been TIAs or mini strokes. David saw his GP and was sent to a walk-in clinic at his local hospital. There he had two ECGs and was told there was a problem, even though he says he felt fine. David was referred to the anticoagulation department and put on warfarin and aspirin, as his cardiologist was concerned about his risk of stroke. He was also prescribed bisoprolol. He had regular blood tests to check he was taking the correct amount of warfarin. He found the tests an interference, especially in the early days when they were frequent, as his clinic did not have appointments but a ‘wait your turn’ system. It could take up to three hours, but he says the results were always given promptly. David has said to his cardiologist that he would prefer to take an alternative to warfarin that does not require blood testing. David feels that NICE may be putting cost before patient care in their decision on approval of a warfarin alternative.  David was already taking tablets for high blood pressure and an ace inhibitor called ramipril, but changed from that as it gave him a dry cough.

In March 2009 David developed atrial flutter, and later atrial fibrillation. He had a cardioversion, but the effects of this did not last. A few months later, David had bad chest pains, and felt faint, hot and sweaty, had blurred vision and found it hard to think. He contacted his hospital and had an ECG and a brain scan (to check if he had had a TIA). The doctors said they thought he had angina. David was then sent for angiogram and treadmill test – a blockage was found and David was told that he would need stents or a bypass. This came as a huge shock to David and his family, particularly since he exercised regularly and was not overweight. David had a triple bypass, which he found very traumatic and painful. He was in hospital for eight days, and then slowly built up his strength at home and through a supervised exercise scheme at his local gym. During the bypass procedure, the surgeon also carried out a cardio ablation relating to David’s AF. Six clots were found which had not been detected by other tests. David feels very lucky that they were found. David was put on amiodarone and ezetimibe by the surgeon, but these affected his liver, and his cardiologist took him off them. His liver soon returned to normal. David does not think that his AF and other heart issues are linked. 

A month after the bypass operation, David’s heart was still in AF and he had a second cardioversion which seemed to put his heart back into normal sinus rhythm. David is disappointed that a couple of months ago he had a spell where he felt dizzy and unwell.  He saw his cardiologist and had a brain scan and a two day heart monitor. Some irregularities were found, so David is due to have a seven day monitor shortly. David had come off of warfarin and was taking aspirin to reduce his stroke risk, but his cardiologist now suggests that David take warfarin instead. David is happy to do this. He also takes 10mg a day of atorvastatin for cholesterol, an ace inhibitor, and 1.25mg of bisoprolol in the morning and evening. He carries a spray with him in case of an angina attack, but has only used it twice. David continues to exercise regularly and wears a personal heart monitor when he does. He sees his cardiologist once a year or sooner if he needs to. David also monitors his own blood pressure. David is very pleased with the care he has received. He asked specifically to see his cardiologist, who is a specialist in electrophysiology and has thoroughly investigated David’s symptoms. David’s cardiologist treats him as an equal, asks David his thoughts, and discusses his treatment in detail. 

David experiences fatigue, but is not sure if that is due to AF or his other heart issue. David thinks that decision makers within the NHS do not pay enough attention to the thoughts and opinions of patients. He feels that decisions are sometimes made by people in management without medical experience, and that resources are not always used efficiently. David feels that money is directing care, rather than consideration for individuals. David raises the point that although some paperwork on decision making and consultation is provided for the public to access, in reality it is not in a format that a lay audience can understand. 

David had never heard of AF before he was diagnosed, and feels it should be promoted much more, including government funding to raise awareness. He advises medical professionals to pay more attention to AF, as it is a ‘silent killer.’ David says that he gave posters about AF to his GP, but these were never put up in the surgery. He finds the websites of the Atrial Fibrillation Association and the British Heart Foundation very helpful and informative. David’s experiences have made him more aware of looking after himself and listening to his body. He advises people to find out about their condition and the treatments available.

Interview held 17.2.12

David Y had his heart rate measured at the gym. When it remained high at rest, he visited his GP.

In January 2009, I was attending a gym twice a week and the gym was controlled by qualified physiotherapists, and one of the ladies there, actually come and took my heart rate and it was a hundred and forty. That same day, two hours later, it was still high. It was still a hundred and forty at resting. So my wife immediately told me to go to our GP, which I did, and the GP sent me to a walk-in clinic at the local hospital. They gave me an ECG, told me to get dressed. I got dressed and then they asked me to come and get undressed again and had a second ECG. Well, as a result of the ECG they said I had a problem which I was unaware of. I wasn’t feeling I had a problem because I was I was going to the gym a couple of times a week and I felt fine. 

While recognising the importance of blood tests, David Y found trips to the hospital very time-consuming.

Well, I found I found it to be an interference really with your day to day life, although at the back of that, knowing full well that I was doing that because my health was at risk, and I needed to as a matter of as a matter of it was compulsory and not, you know, not something I felt I will or won’t do whenever.  No, it was it was an interference because of going to hospital and it it’s very, it’s very time-consuming as well because the local hospital, you’ve got to allocate yourself three hours. That’s from the time of getting there to the time you come away because instead of having a separate anticoagulant clinic, it’s got like, I called it Dracula’s reception, everybody from every clinic goes there and just takes a raffle ticket and really, you know, it takes a long time.

David Y supported the introduction of new drugs, but believed cost prevented them being more widely available.

I’ve already I’ve already made the consultant cardiologist aware, at the last meeting, when he said to me about going back on warfarin, that I, he I said to him, “I understand there’s another tablet that they’ve been testing throughout Europe.” And he said, “What do you feel about it?” And I said, “I’m very supportive. Absolutely supportive of the tablet and, hopefully, it can be introduced in the UK.” Yeah, so I’m very much pro, I, you know, I’ve read what AFA have said about it and I personally don’t, can’t see anything against it. It seems to me, at the moment, NICE are very sceptical because of their cost analysis they’ve done, and I can’t necessarily, as a patient, agree with that because I think they’re primarily putting cost against patient care and patient risk. 

David Y enjoys a good relationship with his cardiologist who he described as ‘superb’.

He’s absolutely superb, this fella. He doesn’t talk down to you. He talks to you. He discusses everything in detail what he thinks will be best, asks you what you think, what, are you willing to go along with that? How do you feel about that? After you’ve had a consultation, he writes to you, and it’s surprising what he writes about because it’s in such detail, probably a page and a half and you think, how on earth did he remember to pick up those points because he wasn’t writing all the time? It’s a total discussion but, like I said to you, when he said to me about the warfarin, he thinks I should take it but, “How do you feel?” was what he said to me, “Are you willing to go along with it?” He’s not forcing me to take it but if you’ve got somebody who’s recommending it, who am I to go against his professional expertise? But no, he discusses everything in detail. He is a lovely person. He’s never trying to push you out. Always feel as though he’s interested in in you as an individual and also as his patient. No, he’s superb. 

David Y is selective about which websites he uses. He chooses recognised sites which ‘know their subject matter’ and have patient interests at heart.

I don’t go on one site because, especially if you go onto an American site or a Canadian site, they’ve got they’ve got a different perception and they deal they deal with it in a different, a different manner. But I do compare I do compare site with site, yeah. But I think that the AF and also the British Heart Foundation are probably, probably the two most prominent that I like to use, and you can ask them questions. You can get booklets. You can see what other people say. They’ve got technical people to answer questions online. I think I think it I think they’re fine, and I and I think they’ve not got a vested interest like commercially. That’s the main thing, its people you can talk to who are there for you as a patient and that’s what really, if the national health treated people like AF and the British Heart Foundation, it’d be different entirely. They’re there they’re there for you and also, of course, they know their subject matter. They’re not generalising. They are like concerned about atrial fibrillation, atrial flutter and they can talk to you about what you should do, how you should, you know, you can talk to a dietician, if you like. You can phone up the British Heart Foundation, talk to a dietician. You can talk to a physical, a physical in training guy, tell you what exercises you should be doing, what rehabilitation you should be doing. Everything is there to help the patient. So no, I’m pretty I’m pretty much fine in knowing where to go. I don’t I don’t take a lot of credence from the these sites what have got a vested interest. I mean some of them are very misleading. You think you’re joining a site and the next thing is a, it then talks about a subscription, you know, so they’re not really interested in you as a patient. They’re more interested in taking your money.