Cost vs Effectiveness

[Gail in Ca]

I am in A-fib and have recently talked to the arrhythmia cardio about my options. He would recommend another cardioversion because he feels that I got almost 2 yrs a-fib free after my 1st cardioversion in '12. I spent some time online researching af and found that it almost always returns, especially if one has atrial enlargement, which I do. He doesn't want to put me on amidiarone (sp?) as he feels it's pretty toxic. So, I would stay on Sotolol, have the procedure and hope it lasts another 2 years?
The thing is, I now have a major deductible of $4000, the cardioversion would be at least $5000, I think, as it was over $4000 in '12 and that didn't include cardio and anesthesiologist fees. But, I had HMO then, and I only paid $125 for the whole thing.
So, I would basically be paying $2500/yr to stay in sinus rhythm, hopefully. It's all a toss up whether it would last.
Or, I could live in AF for the rest of my life, with a 2% stroke risk, even on warfarin. He said it seemed I wasn't sure how I wanted to proceed and to take 2-4 weeks to do the things I normally do, like exercise at the gym and see if it is affecting me that much.
But, I shouldn't wait too long because the heart will want to stay in AF the longer I wait.
Welcome to small business health insurance! I really don't know what to do? That deductible will be a major expense for me, especially if the cardioversion doesn't last. Is 2 years worth it? What would some of you do if you had this dilemma?
I asked the doc if it only lasted a year would I then just keep getting cardioverted? But he said no, if it only goes a year I can't do that over and over each year. He also said most people in my position of having had heart valve surgeries will go into a-fib at some point.
This I never knew, either.

 

[Eva]

... most people in my position of having had heart valve surgeries will go into a-fib at some point.
This I never knew, either.

Gail,

I'm sorry that you had to go from one thing to another.

I never read or heard of what this doctor told you! I hope he is wrong. Does he know what you had gone thru recently? and whether your AF maybe an after-effect or temporary after all?!

How about seeking a different opinion?!

Best of luck and keep us posted.

 

[epstns]

Gail, when I first came home from valve surgery, I was having some afib. I was given amioderone (the toxic one) to help calm things down and give me a chance to heal. I was lucky - my afib resolved and I have been OK since about 4 weeks out from surgery. When I discussed meds with my cardio, he said that although amioderone is supposed to be the med of last resort due to its toxicity, many cardio's use it first ". . . because it just works." He went on to tell me that if I had remained in afib, he would have switched me to multaq. Multaq is very much like amioderone, but without a lot of the toxicity issues. Might be worth discussing Multaq with your cardio.

 

[river-wear]

Hi Gail,

That's a tough spot to be in. I can certainly see why you're hesitating, because even if expense wasn't an issue, if cardioversion doesn't necessarily last and you can't do it over and over what other options are available? (Sorry if that reads harsh. I really don't mean to.) Looking over the longer term, are there other possibilities besides medication? If you're interested, my cardiologist (in Palo Alto) specializes in electrophysiology - Dr. Hardwin Mead.

Best wishes with whatever you choose.

 

[ski girl]

Nine volt battery? Heheh, maybe laughing will help? ;-)

If exercise isn't dangerous, is it worth pushing your heart rate to see if having to do some hard work knocks it back into sinus rhythm? This is just a theory I have . . . .

 

[Gail in Ca]

Ha Ha, I have thought of getting a friend to scare me when I wasn't expecting it, but maybe a good shock would work better and it would be free? Should I stick a fork in my toaster? Just kidding, don't worry, I won't do it!!
I e-mailed the doc and asked about Multaq.
I'm really at a no win situation. Am I destined to live in a-fib? The thought bothers me, but the cardiologist didn't seem too bothered by that possibility, because it probably is what I have to look forward to. I'm going to the gym in the next week and I'll give it a go, maybe taking a cardio class or something. I've only been walking the dog for a couple of years, so I'm out of shape gym-wise. I've gotten lazy.
Thanks, Michelle for the name of your doc. I have a PPO, maybe I will see him! Couldn't hurt and it might save me $5000.
I also e-mailed my regular cardio and my GP, to get their opinions on my dilemma.
I'm glad you all responded. I've been feeling like no one even reads my posts, lately, so Thanks so much, it really made me feel better!

 

[epstns]

Gail - This is sort of a "just in case" idea. When my mom was diagnosed with CHF and chronic afib, her doctor was very compassionate in trying to put my mind at ease. He told me that many people live their lives just fine although they have chronic afib. They have some meds to take and have to be mindful of their energy levels, but if managed properly afib is not a death sentence. Mom had bradycardia (as did I. . . big surprise), so she ended up with a pacemaker, but the afib never was an issue. Sure, she took her Coumadin religiously and did her INR tests to manage it, but life went on and was good until something else (cancer) became her downfall.

I think you're doing the right thing by exploring all the options. Mom had cardioversion once, and it worked for a while, but when she went back into afib, she just learned to live around it. She was a tough little lady, but I think you are just as tough, so one way or the other, you will do fine.

 

[knotguilty]

Sorry to see you have to have the anxiety of having that kind of bill hanging over your head on top of your issues. I want you to know I read your posts and am afraid I cannot offer any advice on AFIB. I will though pray that you get better.

 

[Gail in Ca]

Well I've had feedback from both by own cardio, (he called me and we talked awhile) and an e-mail from the arrhythmia cardio.(this is my own cardio's cardio as he's got some major thing with his heart, too).
My cardio said if I chose cardioversion, he felt it would be the last one I could have. And, after 1, it usually doesn't last as long the 2nd time.
He basically said that my getting almost 2 yrs was really good, but that doesn't guarantee the next one will go that long for me. He also said he feels that my decision to just stay in a-fib would be fine. Other than the valvular disease and enlarged atrium, my heart is functioning well, so he tends to recommend patients like myself to just let it go after a cardioversion or two. He said it's really more important for patients whose hearts are not pumping well to try to get them into regular rhythm. The other cardio addressed Multaq as no better than sotalol which I continue to take. Also, I must have another cardioversion before going on Multaq-it will not get me back to normal rhythm by itself. It's actually a dangerous drug if taken long term while in continuous a-fib.
I went to the gym, did a pilates class that kicked my butt, however, my heart was fine. Just my muscles are unused to the workout!
I'll need to do elliptical for cardio to see if that makes a difference in a-fib. But, I'm getting used to the idea of staying in a-fib.
Concerning a-fib, I guess he feels that most people with valvular disease will be in a-fib at some point.
So that's it for now. I will update how I feel doing more major cardio and weight training in a-fib in the next couple of weeks.
Oh, also, I was told that I could wait no more than 6 mos to make my decision about the cardioversion, so not the hurry I thought it was!

 

[river-wear]

Hi Gail, I'm glad you have some time to think about what you want to do. It's also great to hear that you can be active without feeling poorly.

Can you feel the irregular beats most of the time or does it come and go? I've never experienced a-fib so I am curious.

 

[Nupur]

Hi Gail,

So sorry to hear about your Afib! My left atrium is beginning to enlarge now, I am taking Aspirin now. I have only had flutters so far. Since you are already on Warfarin, maybe just controlling your rate is ok? I discussed that with my mom's doctor in India last year because Amiodarone was horrible for her, although it got her back in sinus in two days. Are there any particular triggers for your Afib? So inspired that you continue with your fitness routine despite the Afib. Feel better! And maybe we should meet up for lunch one of these days again! Best, Nupur

 

[Nupur]

Hi Gail,

So sorry to hear about your Afib! My left atrium is beginning to enlarge now, I am taking Aspirin now. I have only had flutters so far. Since you are already on Warfarin, maybe just controlling your rate is ok? I discussed that with my mom's doctor in India last year because Amiodarone was horrible for her, although it got her back in sinus in two days. Are there any particular triggers for your Afib? So inspired that you continue with your fitness routine despite the Afib. Feel better! And maybe we should meet up for lunch one of these days again! Best, Nupur

 

[Superman]

I went into afib once and needed a cardioversion to come out of it. That was back in 2006. Staying that way would not pass the sleep at night test for me. I would either opt to be zapped again or start discussing pacemaker options. But from the sound of your post, a pacemaker isn't an option?

2006 was before we had deductables, so like you, it wasn't really much out of pocket other than an ER visit co-pay. Didn't even consider what the cost would be if it happened again. Hope it doesn't.

Mine was kind of nuts though - the machine had me a 150 - 200 bpm and fluttering all over the place. It wasn't really a discussion, it was a wheel you in, knock you out, zap you, and we'll talk later. Couldn't imagine trying to live with that. I've been in sinus rhythm since with the occassional palpitation. I get a flip flop what seems like a couple times an hour. I wore a monitor for 24 hours and they said it was fairly normal, but the mechanical valve just makes it more obvious to me.

My cardiologist moved on to the transplant / heart failure group so I have to find a new one. As a precaution, in addition to adults with congenital heart defects / valve issues specialty - I want one who has an interest in electrophysiology.

 

[Gail in Ca]

Thanks, Nupur, I think we should do lunch again!A bad cold that lasted a couple of weeks might have triggered it. But, I don't know for sure. My rate is 88 right now, so it's not the crazy fast flutter like I had before my 1st cardioversion. That's why a pacemaker hasn't been suggested, I guess. If it was fast, I would not have this dilemma. I would get the cardioversion.
I do know what you mean superman about the night time and the irregular rhythm. I'm finally getting used to it.
I still haven't made my final decision about it. Of course I would want to remain in sinus rhythm for many years, but that probably won't happen for me.
I know I could get it done and then set up payments on the balance, but if it only lasts a year, I would not be a happy camper.