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Obesity excluded from AF treatment?

This is bad news and so wrong. I had a catheter ablation for AF in November 2012. If I had been assessed using the new criteria I would not have qualified for the procedure because of the following points:-
  • Ablation for long standing persistent AF of more than 2 years standing would no longer be possible

  • Ablation for paroxysmal or persistent AF will not be allowed for patients with a body mass index (BMI) of more than 40
Over 7 years on and I remain AF free. Before the procedure I couldn't bend to tie up shoe laces as I got too breathless. I sometimes couldn't walk more than a few yards without having to sit and take a breath. Months after the procedure I managed to walk 14 miles in one day. I am proof that n=1 and the procedure can work for those who don't fit the new criteria. I am disgusted that the obese are targeted yet again when they are the people who need the help the most.
 
To put a counter argument, it is rational to provide treatment where it is proven effective. Many procedures provide little or no benefit e.g. stents for stable angina and it makes sense to provide central guidance as CCGs all do different thing which may not be based on up to date best practice. Just look at access to bariatric surgery which I belive should be an option but isn't because of our moralising of the obesity issue.

I imagine a Liverpool consultant is also financially incentivised to carry out procedures so don't assume he doens't have a budgetary dog in the fight.
On the other hand it doses sound as if those new guidelines come with red tape.
 
ickihun said:
I wonder if @Daphne917 and her partner has seen this.....
https://www.medscape.com/viewarticl...DIT_mediadev&uac=291570FY&impID=2302902&faf=1

BMI dictating whether treatment for AF by ablulation has been given as a criteria limit of care.
Click to expand...
Thanks @ickihun it makes interesting reading. At the moment his AF is fairly stable so the alternative meds seem to be working - not sure how he would fare under the ‘2 year rule’ though as he has had his for approx 12 years since his aortic root and aortic valve were replaced!
Love the updated avatar btw
 
Daphne917 said:
Thanks @ickihun it makes interesting reading. At the moment his AF is fairly stable so the alternative meds seem to be working - not sure how he would fare under the ‘2 year rule’ though as he has had his for approx 12 years since his aortic root and aortic valve were replaced!
Love the updated avatar btw
Click to expand...
I can foresee an obese person being told that they need to lose 10% of their body weight to qualify for the procedure and then falling foul of the 2 year rule.

Thanks for posting the link @ickihun
 
Any excuse, it's looking clear.
I guess I should be thankful I'm not diagnosed with AF and the cardiologist discharged me before my bariatric operation as my fast heart beat is also regulated by an increased betablocker med which is noted for to regulate high blood pressure. Anxiety causes faster heart rates too.
I'm sure deligent cardiologists will now be very careful diagnosing obese patients when that patient hasn't received correct weight loss help. I bet litigation lawyers will be salivating over this and other guidelines ruling out full help to patients who are obese due to irregulated natural or injected insulin which is highly documented in a hormone which doesn't help weight loss.
I'm keen to watch this space as a guideline open to neglect and maybe argued immoral.

For some time many feel obesity is a disability and therefore should come under those protective measures.
An 'ism' which should be interpreted as if its being prejudiced against and therefore should also be protected like sexism or racism?
 
NicoleC1971 said:
To put a counter argument, it is rational to provide treatment where it is proven effective. Many procedures provide little or no benefit e.g. stents for stable angina and it makes sense to provide central guidance as CCGs all do different thing which may not be based on up to date best practice. Just look at access to bariatric surgery which I belive should be an option but isn't because of our moralising of the obesity issue.

I imagine a Liverpool consultant is also financially incentivised to carry out procedures so don't assume he doens't have a budgetary dog in the fight.
On the other hand it doses sound as if those new guidelines come with red tape.
Click to expand...
I've read before this there was a cap on how many AFBs were used due to how ineffective they are on some. So an extention to that guideline?
 
Is all areas of diabetes conditions (or side effects) going to face the weight loss requirement?
I hv huge huge sympathy for those who haven't discovered low carb or most of the weight loss methods proved to work mentioned on this forum. They must feel trapped. Poor patients. :( :( :(
Improvement in weight loss through a 'special diet' for insulin resistant patients is becoming dire @Debandez.
 
What about the cost of regular blood tests and out patients appointments for obese people whose AF could be cured by ablation? The cost of my AF to the NHS for the past 6 years has been nil.
 
zand said:
What about the cost of regular blood tests and out patients appointments for obese people whose AF could be cured by ablation? The cost of my AF to the NHS for the past 6 years has been nil.
Click to expand...
It is ridiculous.
I'm still obese but no longer morbibly obese. I'm still working on more loss though. Although I like stable loss than loss then regain.
I'm very very attentive to what my scales tell me weekly and take action to be stricter if no decent loss. I'm determined to get to a more sensible weight, for my height. I hope I hv the luxury of having the choice after the 12mth period. Currently I'm only using basal insulin (with metformin). Only 6units of the triple dose. I'm hoping to reduce further but my hba1c is still in 50s. I'm still not back to swimming either. Any time now I want confirmation that although I'm bleeding orally I can return to the local pool. ENT hv to give me that confirmation.
My legs are starting to look slim. New jeans are soon to be delivered. However my stomach still swells up. Same swellings I had at 22-23st. So looking forward to what my next Ultrascan shows. Food related as swollen at night after I've had a meal. If I just hv a protein nibble instead it's much less prominent. I still feel all circulatory and still linked to chest pains. Of course my fast heartbeat with meds is less obvious, more so since on strong painkillers every 4hrs. .Year in year out. Still on 5mg bisoprolol and all other blood pressure meds. Strange how none needs reducing. None. In fact I'm on more meds since op. I'm hoping that will change but as you have pointed out. I hv no control over that. Just like AF sufferers. It's not a voluntary condition and 10% weight loss may not change anything. I've lost 50% of my overweight weight. In fact more, but no change with speed of beats nor amount of medication for treatment.
So i feel a marker of compliance with no real benefit. Just more patients on the very very long bariatric waiting list before this phantom waiting list for AFB, it seems.
 
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