Age at interview: 75
Age at diagnosis: 74
Brief Outline: Vera felt tired and breathless but put this down to another health condition. A routine blood pressure check and subsequent ECG showed that she had atrial fibrillation. She takes warfarin to reduce her risk of stroke.
Background: Vera is retired and has two grown-up children and lots of grandchildren. She is actively involved in voluntary work. She feels it is important to share information about health conditions. Ethnic background: White British.

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Vera had a routine blood pressure check and was found to have a varying heart rate. She had an ECG and her doctor told her that she had atrial fibrillation. She recalls feeling tired and breathless, but had put these symptoms down to another medical condition. She says she would have gone to see her doctor if she had had more noticeable symptoms.

Vera had never heard of AF when she was diagnosed. Her doctor explained about AF and said she could take aspirin or warfarin to reduce her risk of stroke, and printed out information sheets for her to take away and read. Vera felt that her doctor explained the condition very well – he was reassuring, and she appreciated having time to go away and think, as she feels it is often hard to take in all information given at once. Vera says it was completely up to her to decide which anticoagulant to take. She was not keen on taking aspirin as she had had a stomach ulcer in the past. She discussed the options with her family before telling the doctor that she wanted to take warfarin. 

After starting on warfarin, Vera had blood tests for two weeks and was told to adjust her dose to try and reach the correct level for her. She then began having a finger prick blood test, weekly at first, then fortnightly, and currently monthly. Her finger prick testing and AF is managed by her GP and practice nurse, who she feels she can share any concerns with. She says the finger prick test is very quick, and she immediately gets a print out with which dosage of warfarin to take and her next appointment date. Vera currently takes 3.5mg/day and 5mg once a week, and tries to take her dose at 6pm (but always in the evening).  She does feel that it could be easy to take the wrong dosage of tablet, as the print out sheet only says which colour tablets to take. Therefore she double checks the box and dosage before taking. Vera assumes she will need to keep on taking warfarin indefinitely, and already takes lots of medications, so says this is just another. She does not take any other medication for AF. Vera does have a yellow anticoagulant monitoring book which she carries with her at all times. It contains details such as her name, address and GP, and says that she is on warfarin. Her blood test results and dosage are recorded by the nurse in it. Vera says it would be useful and easily recognisable if she were in an accident. She was advised to avoid cutting herself if possible, as she could bleed easily. She does notice that she bruises easily. Vera says she still gets breathless and tired, but allows herself plenty of time to do things and to rest and recover. She was also advised to avoid grapefruit and cranberry whilst on warfarin.  

Vera’s mother had heart problems, but did not share this information with Vera whilst she was alive. Vera is not sure whether family history has anything to do with her development of AF, but does feel it is important to share health issues with family members, as it could affect them in the future. Her family were surprised when she was diagnosed, but she was relieved to have an explanation for her tiredness and breathlessness. Vera says she does not dwell on her AF, and is not sure whether she is always in AF or just occasionally. Vera is trying to lose weight, but medication she takes for another condition increases her appetite, so she admits to finding it hard. She would like to visit her son in USA soon, and her doctor has said that her AF should not restrict her travelling. 

Vera remembers when she was a child, her parents struggled to pay a healthcare bill for her (before the introduction of the NHS). She feels we are very fortunate to have the NHS, and has ‘nothing but admiration’ for the supportive and positive staff she has encountered. She feels that medical professionals and family members should be encouraging of people with AF. She urges people diagnosed with AF to try not to worry and to take the medication that is prescribed. Vera says she would look on the internet if she wanted to find further information on AF, but feels her GP’s information was sufficient. Vera feels that decision-makers within the NHS should continue to focus on patients and staff, and not just finances. Vera noted that her friends and family had not heard of AF when she was diagnosed. However, she is unsure whether public education on AF would be effective, as she feels people are given so many health-related messages that they may not take it in, unless they have some personal experience or interest in the condition. 

Interview held 28.7.12

Vera’s AF was picked up by a practice nurse during a routine blood pressure check.

I had to go for a no, it was a six monthly blood check blood pressure check, and I had a different practice nurse to the one I usually do, and she took it two or three times and it was it sort of varied every time and so she said, “I’ll take it once more but I really think we ought to do an ECG.” So I said, “Okay.” So she made me an appointment for the next day. That was at the end of January this year. And I had this appointment and had the ECG and when she’d taken it, it was a different nurse, and she looked at it and she went straight out of the room and I thought, “Oh, something must be wrong.” And she went to find my doctor. If she’d said to me, “I need to tell your doctor,” I could have said to her there and then, “Oh, I’ve got an appointment to see him this afternoon anyway.” So I did. I went back in the afternoon and he said, “I have to tell you, you’ve got atrial fibrillation.” And I’d no idea what that was, so he described it and he gave me, he also printed out about six pages of information about it, which I found very interesting. 

Vera carries a yellow booklet which includes details of her blood test results.

Yeah, you have to keep it with you at all times and it it’s got your name and your doctor’s surgery and everything on it, name and address, that sort of thing, and every time you go for a blood test they record in it what the reading was for that particular time, and what dosage you’re on. So if you keep it with you at all times, if you happen to be in an accident it it’s handy in your handbag, and it’s yellow so it does show up. That that’s what it’s for. We did get another yellow bigger pamphlet telling you all the things, which I’d already got in the leaflets from the doctor anyway, but I always remember to keep that little yellow booklet with me.

Vera explained the routine of blood testing since she started taking warfarin.

Anyway, I looked at all the things and I looked talked it over with one of my sons and he said, “Well, do what you feel best.” So I decided to start the warfarin. So I had another long form about that to look at and he started me off, gave me a prescription for all the different strengths straight away, and so I was able to pick them up from the chemist’s straight away. And I had to take one that day, one the next day, both in the evening and go back the next morning for a blood check, blood test. And that was sent through to the hospital in [town name] and they said, “They’ll be ringing you this evening to tell you what dose to take from now on.” 

That happened for two weeks, I had to go for a blood test for two weeks and then they said, the doctor said, “Now you can have just the finger prick test.” So I do that now. Sometimes I go once a week, sometimes its two weekly, but this time it’s been not for a month, and I do try and remember to take whatever dose it is about six o’clock in the evening. I’m not always spot on the ball with that but in in the evenings. And I was warned not to try not to cut myself because I would bleed much more easily, and so far I haven’t.

I mean it’s a bit of a bother sometimes thinking, “Oh, I’ve got to go for another blood test.” But I’m in and out so quickly, especially when it’s just a little finger prick. It’s amazing, you know, you, a little drop of blood goes onto this thing and onto the machine and works it out, and then I get a print out of what the dosage I’ve got to take for either the next week or whatever, and given an appointment then for the next time. 

Vera found it reassuring when her GP gave her printed information to take away and discuss with her sons before deciding on treatment options.

I went back in the afternoon and he said, “I have to tell you, you’ve got atrial fibrillation.” And I’d no idea what that was, so he described it and he gave me, he also printed out about six pages of information about it, which I found very interesting, and he said, “There are two ways we can treat it, either with aspirin or with warfarin.” And he talked me all through that, and this was all on these information pages anyway. So I he said, “Come back in a week. Read it all through and consider it. Talk it over with your sons if you want to, and then come back and let me know what you want to do.” So I took it all home and he was very reassuring about it. You know, he didn’t make me frightened or anything and, in a way, I was quite glad to know because I’d been getting a bit breathless before that and I’d got very tired. 
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