Great points! In my opinion traditional healthcare does not do a great job educating about a condition nor does it give patients a chance at adjusting lifestyle before jumping to medical therapy. Guidance on lifestyle adjustments is poor and even when made, follow through and feedback for patients is lacking.
Decision making based on population based evidence is very nuanced when providing personalized care.
In regards to Afib management, even if a lone episode occurred there is some vulnerability to recurrence. Unfortunately I have seen too many young individuals suffer devastating neurologic events off blood thinners. Management is often a game of probability and real assessment of individualized risks/benefits, but the consequences in this condition are dire.
I have a diagnosis of paroxysmal AF. Low burden. Vagal type. Known triggers. I take Apixiban because of CHADSVASC. I don’t like the binary approach to AF. No distinction between low burden and permanent. Pill-in-the-pocket is at trial stage 3. It could result in an 80% drop in prescriptions. Eliquis has generated $65 billion in revenue in the 13 years it’s had patent protection. At least I live in Mexico where I buy generic for <$60 bucks a month. Before long, the Xa DOACs will be superseded by the XI medications. Back to hundreds a month. I’m way past cynical.
I haven't found a lot of cardiologists who are willing to have such discussions with patients. But in their defense, if something goes wrong the cardiologist would be liable.
Agree 100%. If we can leave more time for a deeper discussion it will benefit both sides. The best I can do for my patient is to arm them with all the necessary information and let them decide. Our healthcare system is a profit-machine because it makes the physician the decider and a lawsuit is meant to even the playing field. That’s only led to defensive medicine, which burns out doctors and harms patients.
Great points! In my opinion traditional healthcare does not do a great job educating about a condition nor does it give patients a chance at adjusting lifestyle before jumping to medical therapy. Guidance on lifestyle adjustments is poor and even when made, follow through and feedback for patients is lacking.
Decision making based on population based evidence is very nuanced when providing personalized care.
In regards to Afib management, even if a lone episode occurred there is some vulnerability to recurrence. Unfortunately I have seen too many young individuals suffer devastating neurologic events off blood thinners. Management is often a game of probability and real assessment of individualized risks/benefits, but the consequences in this condition are dire.
I have a diagnosis of paroxysmal AF. Low burden. Vagal type. Known triggers. I take Apixiban because of CHADSVASC. I don’t like the binary approach to AF. No distinction between low burden and permanent. Pill-in-the-pocket is at trial stage 3. It could result in an 80% drop in prescriptions. Eliquis has generated $65 billion in revenue in the 13 years it’s had patent protection. At least I live in Mexico where I buy generic for <$60 bucks a month. Before long, the Xa DOACs will be superseded by the XI medications. Back to hundreds a month. I’m way past cynical.
I haven't found a lot of cardiologists who are willing to have such discussions with patients. But in their defense, if something goes wrong the cardiologist would be liable.
But no liability for the side effects and deaths from approved drugs. The system is shattered.
Agree 100%. If we can leave more time for a deeper discussion it will benefit both sides. The best I can do for my patient is to arm them with all the necessary information and let them decide. Our healthcare system is a profit-machine because it makes the physician the decider and a lawsuit is meant to even the playing field. That’s only led to defensive medicine, which burns out doctors and harms patients.