Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi there, hearties. It's Angela here from Healthy Hearties. I am here this morning with Dr Warrick Bishop. He is a very busy cardiologist all the way from Australia, right down the bottom in Tasmania. So thank you very much for joining us today. Hope you're all okay in Australia and in the pandemic, but we are really looking forward to speaking to you today. So thank you so much for your time. Angela, it's a pleasure to join you, and it is fantastic what this technology allows us to do. I'm sitting here in Hobart, and there you are in the UK, and we're able to share information, which is just fantastic. Yes, and thank you so much. So we already covered last week a fantastic little segment all about stents. So if you missed that segment, I can always post the link below so that you guys don't miss out on Warrick's video all about stenting. But today we want to go through some other questions that have been posted quite frequently in the group. And when I reached out to you, Hearties, this came up quite a lot. And it might be different in Australia, but you can give us your experience, Warrick, the recommendations that you have for your patients. So as a cardiologist, it's great to hear your side of things. But one of the most common questions we receive is how often should someone be seeing you? And obviously we have best case scenario if healthcare allows it. But what would you recommend to your patients for someone with a few different conditions perhaps? after a stent or after a heart attack or if they had heart failure? So, look, I think that's a really important question. It's good for people to have some idea of what may be expected further down the road for their own care. Truth is it's often and it can be a bit variable at times. The number of times you need to see... an individual is generally closely related to how stable or unstable they are and based on your requirement to either assess a therapy or potential side effect from a therapy in general terms i tend to see people about two weeks after they've been in hospital whatever that may be if they've had an angiogram if they've had atrial fibrillation if we've done a cardioversion if they've got elevated blood pressure, whatever it might be, I often try and see them at about two weeks. And certainly if they've had cardiac failure because we might be using diuretic drugs, I'm doing quite a bit of testing of their electrolytes, checking their kidney function early on to make sure we're not drying out their kidneys and causing kidney damage. So in that early part, we're doing lots of testing and getting the drugs adjusted also. cardiac failure as you're aware we want to push the doses up to the highest levels possible that the patient tolerates because we know they get incremental benefit if we can have them on maximal doses so for cardiac failure patients i might see them at one to two weeks in the rooms with up-to-date bloods we might be pushing up their ACE inhibitor or their angiotensin II blocker. These are the blood pressure tablets that take a load off the heart. We might be checking the diuretic therapy. We'd be pushing up their beta blocker as tolerated. We'd be assessing them and seeing if there are any other agents that should be considered, particularly if their heart's going too fast. So that's all pretty busy. And I often say to people, I'll see you. quite a few times early on in the process until we've got everything bedded down. But the flip side of that, Angela, is once we've got someone nice and stable, I don't think you need to see them that often. And I will often see my cardiac failure patients on a yearly basis if they've been stable, but with a premise that they have to come back at the first sign of anything not being right because I can't possibly. know unless they come back and let me know. I've also, in the past, I used to leave some of my patients who maybe had a stent or a heart attack. I used to let them go back to the GP for ongoing follow-up. But now, even with patients who have been commenced on an aspirin and statin and beta blocker or a blood pressure tablet, I'm starting to make sure that I follow up these people once a year as well. And part of the reason for that is that I've come across patients who I'd discharged back to their GP five or 10 years ago and they turn up now for, you know, a follow-up for whatever it might be. And I've realised in that five or 10-year intervening period that the guidelines... have been informed by new research which hasn't been applied to that patient and so i now sort of think it's almost worth seeing these people every year or two just to make sure that i'm making sure that they're getting the most up-to-date information so you would know yourself uh cholesterol level targets have dropped over the last five to ten years substantially and the europeans uh with their recent uh guidelines for cholesterol have really driven LDL cholesterol levels down to very low levels. And no one was even thinking that space 10 years ago. So did I answer your question? Yes. Yeah. And I mean, I think all of our hearties are thinking, gosh, I wish he was my cardiologist. Because here in the UK, the NHS is obviously very busy. In the pandemic, a lot of people have had their appointments skipped. pushed back, no sign of continuing, you know, for the near future. So a lot of people do worry, no one's really checking on me. And a lot of it is pushed back onto the GP. And I think GPs are fantastic and a lot of pressure, but I think ideally, and same for me, I'd like everyone to see their cardiologist once a year, but it's not always possible. And I think in that acute phase, In particular, it would be amazing to see someone like you regularly until they're stable. But of course, the patient doesn't know that, so they don't know whether they are stable. So there's a little bit of a grey area here in the UK where, you know, those first few weeks after an intervention or after a hospital stay, they do feel a little bit lost in the wilderness. Yeah, of course. I mean, most people see the cardiologist after about six weeks in an ideal world after an intervention. And then it's a bit hit and miss after that. But as you say, it's reassuring to say if they're stable, there's nothing really you need to follow up with, you know, immediately unless they have problems. I guess in the first instance for our hearties, they would go back to their GP and say, I'm having problems. Can I go back to the cardiologist? Yeah. Look, the COVID situation has been interesting and challenging, obviously. In Australia, our nationalised health system has created an item number, an opportunity for us to bill for phone consultations. So one of the really nice aspects for that is if If all I need to do is check in with a patient on their breathing or shortness of breath or swelling of ankles, I can give them a call. I can have them have blood tests for their kidneys a couple of days prior. I can look at their kidney function. I can ask them about their swelling of ankles, shortness of breath. I can adjust their diuretics. over the phone without them even having to come in and that's been it's been a real bonus actually i think it's made life easier for the patients by a country mile which has been good and that should you know possibly be the future of medicine anyway saves everyone time and it makes sense and if you are breathless coming up to a hospital appointment is pretty rough So that is a really good sort of bonus that's come out. In the UK, I think it's hit and miss whether people have received bone consultations or nothing. I was going to say one of the things I would say to patients is... If you've been spread out on your consultations, which is fine if your doctor has thought that you're pretty stable, if there is something wrong, you have to own that. You do have to drive being seen sooner. If you think you're having a problem with the tablet, please don't stop it unilaterally. Please talk to the person who put you on it so you understand what it's meant to be doing. If you really are having a side effect, it might be a lower dose or an alternate or... alternate days or there will be a solution, but your doctor will have put you on a medication with a particular thing in mind to rest the heart, to anticoagulate, reduce the risk of stroke, to make sure you don't have a heart attack out of the blood. It'll be something. So if I could empower whoever's listening to this, if you think you're not right, if you think there's something that's just needs to be sorted out, don't put it off. Don't get checked. It's a stitch in time, but it can be so important. Yeah, and you have to push for that often, don't you? But I think the hearties sort of know that, and a lot of them are used to doing that. They go back to the GP and say, it's not right. Let's look at it. It's not right. Oh, good. That's really great advice. And as we were talking before, we came on to record you were saying that you've put a lot of information for heart patients up on your website can you tell us a little bit about that sure absolutely now we mentioned that in the previous interview and um what i've done is i've put together a whole lot of resources that I call the healthy heart network. That's it's free. It's accessible to anyone. And of course, cause it's on the net, it's worldwide. There are options for purchasing bits and pieces like books or programs and learnings, but we've got a whole free gamut of stuff, which includes podcasts, which includes newsletters, which includes videos as well. And the feedback has been really good. People find. Good information, valuable information. I can assure you that I've vetted all the stuff that's on that website. So the podcasts are not left field, random, unbalanced. They're good information so you can have good conversations with your medical providers. And as I said to you before, Angela, I'm very happy to share that with you and your hearties. Oh, great. Thank you. So I'll pop a link below the video in the comments. And I will send people to that because I think the more we learn, the better that you say, the more empowered we are. And I think that's really important. And I always encourage people to know more about their heart and the medications that they're on. So thank you for sharing that. It's a pleasure. Well, thank you very much for your time. Thank you for giving it up today. And we will speak again soon. Thank you, Angela. It's my pleasure. And goodbye. Have a great day. Okay. Bye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
