Post surgery: Cardiologist no longer part of routine?

[oo0My_Valve0oo]

Hello All,

Quick history: Aortic valve replacement (biological) June 2021. April 2022 healthcare organization sent me a message stating my cardiologist had retired. Can’t copy/paste the message. In summary, I am to use a Cardiology call center phone number for questions. Otherwise my primary care physician would be handling everything from then on. ”Most chronic, stable heart conditions can be managed by your PCP.” A replacement cardiologist will only be assigned to those with unstable urgent cardiac issues.

I am wondering how common it is to be released from a cardiologist’s care post surgery and how soon?

I had been thinking I would have a cardiologist for the rest of my life, given the significance of the heart and the serious and invasive nature of open heart surgery.

 

[dick0236]

Since my surgery in 1967 I've normally seen a Cardiologist every couple of years for testing, etc. My PCP's took care of INR and other issues. If my PCP felt it was necessary he would refer me to the Cardio. That rarely happened. However, now that I've gotten to be an "old" man, issues have developed that require me to have more frequent contact with both my PCP and Cardio.

 

[Chuck C]

It sounds like your insurance carrier is trying to get by on the cheap. At your next PCP visit, I would request a referral to a cardiologist. Perhaps he will be on the same page with you in the importance of regular cardiology appointments. If not, you may need to be a little creative in coming up with a reason why you "need" to see a cardiologist. Once you get your cardiology visit, they might schedule you for regular cardio check ups, which is what you really want for valve patients, especially just a year out from surgery.

My mom has an HMO which tries to do things on the cheap and I've had to push to see specialists for her memory issues, as well as other issues over the years. Her PCP was fully on board with referring her to a neurologist. When they called us to schedule the appt, HMO management had switched the referral to the geriatric unit, not neurology, where we have already visited a few times. I pushed back and eventually was able to get her PCP to insist that she see a neurologist. It took a few phone calls and emails to get her to a neurologist, but we eventually got the appointment we wanted. She is now considered a patient of his and scheduled for a follow up in a year. Usually there is a way, but with the providers trying to do it on the cheap, it will take some effort to get what you want, in my experience.

 

[pellicle]

hey mate ...

I am wondering how common it is to be released from a cardiologist’s care post surgery and how soon?

I don't know where on the planet you are, so I'll assume that means you're from the USA (seems a reasonable assumption). I can't speak to what's normal there, but in Australia things have changed and the post op followup is at first the surgeon then that's increasingly handed off to the cardiologist. I've seen my surgeon at 3months, 6 months, 1 year, 2 years and then I think 5. In contrast I saw my cardiologist (the same one since the start of finding my aneurysm) at something like yearly for the first few years then something like every 2 or 3 after that.

Private Health cover in Australia works perhaps differently and we may have a lot more say in what we get for what pay for.

 

[oo0My_Valve0oo]

I should have stated that I am in the US and have added it to my displayed account information.

I only joined this particular healthcare organization in 2021. The PCP was new to me. Previously under a different organization I had the best doctor of my lifetime. He was great at being a personal physician. My company no longer offered the organization he was available through. The new organization reminds me of a branch of government. It is less personal and more restricted from top to bottom of that which a patient has direct contact with. I thought this new organization would be the best of the options available to me in part due to it being presented as a unified system. However that is not how it operates behind the facade. It is a system broken into branches/departments that are slow and inefficient to cross communicate. There is resistance and resentment in their workforce which interferes with patient care in every way from treatment to billing.

I excuse a degree of things because my experiences transpired following the Covid-19 pandemic. People in healthcare have been in a war, some areas more extensive than others. I spoke with many nurses and “travel nurses” about their experiences during the peak of Covid. At the time of my surgery there was a shortage of nurses and everyone was encouraged to work on their days off. Management felt lucky they had any nurses working a shift. Patient care was not the primary concern. Attaining bare minimal staffing was more important and patient’s needs were not regularly met adequately.

With this organization I have two hospitals to choose from which are only a difference of 3 minutes driving distance but they are both around 45 minutes away in different directions when there is no traffic. There is only a limited satelite clinic within a couple of miles from me. I have had bad experiences at all three. It is still probably the best option given any alternatives available to me.

 

[tom in MO]

Having a biological valve means you are by definition "not stable" particularly if you are 70yo. I'd suggest doing what Chuck C suggested and discussing this at your first meeting with your PCP.

 

[oo0My_Valve0oo]

Having a biological valve means you are by definition "not stable" particularly if you are 70yo. I'd suggest doing what Chuck C suggested and discussing this at your first meeting with your PCP.

Not sure who you are referring to. I might have missed some details of other posts and their author. I am in my early 60’s. Was the “70yo” just a general reference to the point when things change? I had my first meeting with this PCP in May 2021. That was actually the only in person meeting/examination I have had with him. I have interacted multiple times through their messaging system though.

You said, ””…by definition “not stable”” perhaps that needs clarification? Offsetting advantages of the longer lasting mechanical valve is being on blood thinners for the rest of your life. That in itself presents a degree of instability because you are always monitoring, medicating and dieting to maintain a targeted coagulation stability.

The risk of stroke from blood clots was my primary concern which lead me to choose a biological valve. I also did not want to be on medication for the rest of my life. I did not discover this forum until my post-surgery recovery period. There are strong cases made for chosing a mechanical valve and I probably would have if I had access to this forum sooner. Yet having experienced the post-surgical period on blood thinners I am happy that is over. There are other options which do not require blood sampling but my healthcare organization prescribes Warfarin/Coumadin so I was getting poked weekly. The lab work is expensive. My veins are difficult to target and a greater percentage of blood sampling was extra painful and took longer before attaining success.

 

[pellicle]

You said, ””…by definition “not stable”” perhaps that needs clarification?

I'm going to go out on a limb here and say that he may mean that bioprosthetics are known to suffer Structural Valve Degradation. This is not a sometimes, its inevitable. Its also known that the older you are at surgery (to fit the valve) the longer you'll get before SVD causes a need for reoperation.

For instance:
https://www.ahajournals.org/doi/10.1161/JAHA.120.018506

The implantation of bioprosthetic heart valves (BHVs) is increasingly becoming the treatment of choice in patients requiring heart valve replacement surgery. Unlike mechanical heart valves, BHVs are less thrombogenic and exhibit superior hemodynamic properties. However, BHVs are prone to structural valve degeneration (SVD), an unavoidable condition limiting graft durability. Mechanisms underlying SVD are incompletely understood, and early concepts suggesting the purely degenerative nature of this process are now considered oversimplified. Recent studies implicate the host immune response as a major modality of SVD pathogenesis, manifested by a combination of processes phenocopying the long‐term transplant rejection, atherosclerosis, and calcification of native aortic valves. In this review, we summarize and critically analyze relevant studies on (1) SVD triggers and pathogenesis, (2) current approaches to protect BHVs from calcification, (3) obtaining low immunogenic BHV tissue from genetically modified animals, and (4) potential strategies for SVD prevention in the clinical setting.​

​

I did not discover this forum until my post-surgery recovery period. There are strong cases made for chosing a mechanical valve and I probably would have if I had access to this forum sooner.

well I don't think its a massively significant issue either way, especially if this is your first surgery. The more I work with people the more I find that people taking control of their INR and managing themselves (the best way IMO) is actually quite rare and people are often not really as dilligent as they could be.

 

[pellicle]

one of my favourites and no doubt a strong influence on the reasons why so many surgeons recommend patients get a tissue valve

because knowing this and the stats on compliance they see less harm in the risks of re-operations.

I'm inclining more towards that view myself (but am personally happy with my own situation and attitudes to drugs and their taking)

 

[carolinemc]

Not sure who you are referring to. I might have missed some details of other posts and their author. I am in my early 60’s. Was the “70yo” just a general reference to the point when things change? I had my first meeting with this PCP in May 2021. That was actually the only in person meeting/examination I have had with him. I have interacted multiple times through their messaging system though.

You said, ””…by definition “not stable”” perhaps that needs clarification? Offsetting advantages of the longer lasting mechanical valve is being on blood thinners for the rest of your life. That in itself presents a degree of instability because you are always monitoring, medicating and dieting to maintain a targeted coagulation stability.

The risk of stroke from blood clots was my primary concern which lead me to choose a biological valve. I also did not want to be on medication for the rest of my life. I did not discover this forum until my post-surgery recovery period. There are strong cases made for chosing a mechanical valve and I probably would have if I had access to this forum sooner. Yet having experienced the post-surgical period on blood thinners I am happy that is over. There are other options which do not require blood sampling but my healthcare organization prescribes Warfarin/Coumadin so I was getting poked weekly. The lab work is expensive. My veins are difficult to target and a greater percentage of blood sampling was extra painful and took longer before attaining success.

Coag machines only require a finger poke and a drop of blood. So you would not have to worry about the big needles unless you are over 4.0. Something for you to think about when the bio ones no longer works.

 

[carolinemc]

It sounds like your insurance carrier is trying to get by on the cheap. At your next PCP visit, I would request a referral to a cardiologist. Perhaps he will be on the same page with you in the importance of regular cardiology appointments. If not, you may need to be a little creative in coming up with a reason why you "need" to see a cardiologist. Once you get your cardiology visit, they might schedule you for regular cardio check ups, which is what you really want for valve patients, especially just a year out from surgery.

My mom has an HMO which tries to do things on the cheap and I've had to push to see specialists for her memory issues, as well as other issues over the years. Her PCP was fully on board with referring her to a neurologist. When they called us to schedule the appt, HMO management had switched the referral to the geriatric unit, not neurology, where we have already visited a few times. I pushed back and eventually was able to get her PCP to insist that she see a neurologist. It took a few phone calls and emails to get her to a neurologist, but we eventually got the appointment we wanted. She is now considered a patient of his and scheduled for a follow up in a year. Usually there is a way, but with the providers trying to do it on the cheap, it will take some effort to get what you want, in my experience.

Like I go once or twice a year, more if there is something going on. like my irregular heartbeat. They are going to do an echo on my legs since i do have edema and weeping edema. Your advice on the checkups are spot on.

 

[catwoman]

I am in the U.S. My St. Jude mechanical was implanted in June 2003.
I have seen a cardiologist at least once annually since then. I am stable on warfarin and home-test. I adjust my own dosage, if needed (which is seldom).

I would NEVER agree to let my own primary care provider monitor take over my cardiac care. Reason: A PCP has a little bit of knowledge about a big number of conditions, but a specialist is just that: He/she is more of an expert on the heart, vascular system, brain, kidneys or whatever.

Cardiac situations can turn on a dime. Symptoms can come on so slowly that by the time you notice them, it can be a very serious problem. I saw it happen to my late father-in-law 10 years after his first MVR (porcine). By then, he needed 2 heart valves replaced, 4 bypasses and ascending aorta rebuilt. I heard either the surgeon or cardiologist tell him that he might not survive his surgery; he did, but with great difficulty.

Advocate for your health. Don't let insurance folks who look up information in a book tell you what to do.

 

[Chuck C]

Advocate for your health

I could not agree more. Ultimately, we each need to advocate for our own health and the health of our loved ones.

 

[Chuck C]

I had been thinking I would have a cardiologist for the rest of my life, given the significance of the heart and the serious and invasive nature of open heart surgery

One thing that a cardiologist has is specialized training in listening for murmurs and other irregular sounds.

After the discovery of my heart murmur, I had a number of other doctor visits for other issues. I participated in 2 boxing events, which each required a physical for clearance before the match and then another physical the day before the match. My own PCP was the the only regular MD who picked up the fact that I had a heart murmur. So, seeing non-specialized MDs, 1 out of 5 picked up my murmur. On the other hand, during this time I saw 5 different cardiologists, as I sought other opinions and options and all clearly heard the murmur right away. The point being, cardiologists have special training in this area. You want someone who has special training and a lot of experience listening to a prosthetic heart valve and knows what it should sound like.

You have a tissue valve which is subject to structural valve deterioration. While it is important for all prosthetic valve patients to have cardiology follow ups, it is arguably even more critical for tissue valve recipients to have them, because, should your valve start to deteriorate, you want to know that as soon as possible so that they can start monitoring you more closely and take action before damage occurs. No one can say for certain how soon your tissue valve will start to calcify and deteriorate. Hopefully that will be many years away for you, but sadly, for some it happens after only a few years.

Anyway, as @catwoman indicated, we really need to advocate for our own health, and I hope that you succeed in getting a referral to a cardiologist who can continue to follow up with you.

 

[pellicle]

Reason: A PCP has a little bit of knowledge about a big number of conditions, but a specialist is just that: He/she is more of an expert on the heart, vascular system, brain, kidneys or whatever.

^^this^^
(*note: but only a good one, because despite popular opinion there are bad ones)

 

[tom in MO]

Not sure who you are referring to. I might have missed some details of other posts and their author. I am in my early 60’s. Was the “70yo” just a general reference to the point when things change? I had my first meeting with this PCP in May 2021. That was actually the only in person meeting/examination I have had with him. I have interacted multiple times through their messaging system though.

You said, ””…by definition “not stable”” perhaps that needs clarification? Offsetting advantages of the longer lasting mechanical valve is being on blood thinners for the rest of your life. That in itself presents a degree of instability because you are always monitoring, medicating and dieting to maintain a targeted coagulation stability.

The risk of stroke from blood clots was my primary concern which lead me to choose a biological valve. I also did not want to be on medication for the rest of my life. I did not discover this forum until my post-surgery recovery period. There are strong cases made for chosing a mechanical valve and I probably would have if I had access to this forum sooner. Yet having experienced the post-surgical period on blood thinners I am happy that is over. There are other options which do not require blood sampling but my healthcare organization prescribes Warfarin/Coumadin so I was getting poked weekly. The lab work is expensive. My veins are difficult to target and a greater percentage of blood sampling was extra painful and took longer before attaining success.

Sorry I meant <70yo. There is no hard and fast age, <60 works too. Biological valves can have a finite life especially if you are younger. That's why routine echos are prescribed by some cardios for patients with a biological valve.

 

[ejc61]

Hello All,

Quick history: Aortic valve replacement (biological) June 2021. April 2022 healthcare organization sent me a message stating my cardiologist had retired. Can’t copy/paste the message. In summary, I am to use a Cardiology call center phone number for questions. Otherwise my primary care physician would be handling everything from then on. ”Most chronic, stable heart conditions can be managed by your PCP.” A replacement cardiologist will only be assigned to those with unstable urgent cardiac issues.

I am wondering how common it is to be released from a cardiologist’s care post surgery and how soon?

I had been thinking I would have a cardiologist for the rest of my life, given the significance of the heart and the serious and invasive nature of open heart surgery.

I've been under my cardiologist's care both a few years prior to surgery and to the present day. I can't imagine not. If your retired cardio was part of a bigger practice, I'd think about going to one of them for at least a consult and a discussion of this matter.

 

[carolinemc]

I've been under my cardiologist's care both a few years prior to surgery and to the present day. I can't imagine not. If your retired cardio was part of a bigger practice, I'd think about going to one of them for at least a consult and a discussion of this matter.

I see most of the time a Cardio Nurse and then if there is a need for a consult, we then send me to the Cardio Doctor. We are still trying to figure out what is cause my irregular heartbeat. I bet it is hormones due to the fact I am in the change of life phase. LMAO!

 

[oo0My_Valve0oo]

One thing that a cardiologist has is specialized training in listening for murmurs and other irregular sounds.

After the discovery of my heart murmur, I had a number of other doctor visits for other issues. I participated in 2 boxing events, which each required a physical for clearance before the match and then another physical the day before the match. My own PCP was the the only regular MD who picked up the fact that I had a heart murmur. So, seeing non-specialized MDs, 1 out of 5 picked up my murmur. On the other hand, during this time I saw 5 different cardiologists, as I sought other opinions and options and all clearly heard the murmur right away. The point being, cardiologists have special training in this area. You want someone who has special training and a lot of experience listening to a prosthetic heart valve and knows what it should sound like.

You have a tissue valve which is subject to structural valve deterioration. While it is important for all prosthetic valve patients to have cardiology follow ups, it is arguably even more critical for tissue valve recipients to have them, because, should your valve start to deteriorate, you want to know that as soon as possible so that they can start monitoring you more closely and take action before damage occurs. No one can say for certain how soon your tissue valve will start to calcify and deteriorate. Hopefully that will be many years away for you, but sadly, for some it happens after only a few years.

Anyway, as @catwoman indicated, we really need to advocate for our own health, and I hope that you succeed in getting a referral to a cardiologist who can continue to follow up with you.

I never had an in person exam or consultation with the cardiologist. They were all online video. My impression of those consultations were that he was overqualified to be basically scheduling and describing processes in a very general way and he made mistakes even with those menial tasks. However there were other doctors doing echocardio with the radioactive solution from the heart dept. Not "Cardiologists." The surgeon and anesthesiologist I had confidence in and these doing the tests as well. I just learned my PCP also is leaving the area so I have been assigned someone new starting Sept 1 2022.

 

[carolinemc]

I never had an in person exam or consultation with the cardiologist. They were all online video. My impression of those consultations were that he was overqualified to be basically scheduling and describing processes in a very general way and he made mistakes even with those menial tasks. However there were other doctors doing echocardio with the radioactive solution from the heart dept. Not "Cardiologists." The surgeon and anesthesiologist I had confidence in and these doing the tests as well. I just learned my PCP also is leaving the area so I have been assigned someone new starting Sept 1 2022.

Strange when all the Hospitals were open for patients in cardiac clinics. They cannot do a real checkup exam over online. Mistakes can be made this way. In-person is the only way to do echo and EKG. So sad you were seen by other than doctors and surgeons when you did not need them. I have had echos by a trained licensed cardio tech and EKG by trained and licensed nurses. This is what makes patients not want to be seen by a specialist. Chaos. Hope it gets better for you soon.