Managing Atrial Fibrillation and Heart Failure Medications Safely

Medications for Atrial Fibrillation and Heart Failure

Hello Doctor, over a year ago I fainted and was diagnosed with atrial fibrillation.
Three months later, I developed heart failure (Ejection Fraction ≤ 35%).
Currently, my heart rate often exceeds 100 bpm.
The doctor has prescribed cardiac medications including Concor (Bisoprolol), Lisinopril, Rhythmol (Propafenone), and Entresto (Sacubitril/Valsartan), along with diuretics and anticoagulants.
I found online that some of these four medications may not be suitable to use together, and Lisinopril may not be effective for atrial fibrillation.
Should I bring this to my doctor's attention?

du, 70~79 year old female. Ask Date: 2024/05/10

Dr. He Dongjin reply Cardiology

Hello, you can discuss with your physician to hear his opinion; it's not necessarily contraindicated to use them together.
Ping An Changhua Hospital cares about you.

Reply Date: 2024/05/10

More Info

Managing atrial fibrillation (AF) and heart failure (HF) requires a careful and coordinated approach, especially when it comes to medication management. Given your history of AF and heart failure with a reduced ejection fraction (EF ≤ 35%), it is crucial to ensure that your medications are both effective and safe.
Atrial fibrillation is characterized by an irregular and often rapid heart rate, which can lead to various complications, including stroke and heart failure. The management of AF typically involves rate control, rhythm control, and anticoagulation to prevent thromboembolic events. In your case, the medications prescribed—Kankun (likely a beta-blocker), Lisinopril (an ACE inhibitor), Rhythmol (an antiarrhythmic), and Entresto (a combination of sacubitril and valsartan)—are commonly used in the management of heart failure and AF, but their interactions and individual effects need to be closely monitored.

1. Kankun (Beta-blocker): This medication is often used to control heart rate in patients with AF. It can help reduce the heart rate and improve symptoms of heart failure. However, it is essential to monitor your heart rate and blood pressure regularly, as excessive dosing can lead to bradycardia (slow heart rate) or hypotension (low blood pressure).

2. Lisinopril (ACE Inhibitor): This medication is beneficial for heart failure as it helps reduce the workload on the heart and improves symptoms. It is generally safe to use with beta-blockers and is often prescribed together. However, renal function and potassium levels should be monitored, as ACE inhibitors can affect kidney function and potassium levels.

3. Rhythmol (Antiarrhythmic): While Rhythmol can be effective in maintaining sinus rhythm, it may not be the best choice for everyone, especially in patients with heart failure. It is crucial to discuss with your physician whether this medication is appropriate for your specific situation, particularly given your reduced ejection fraction.

4. Entresto (Sacubitril/Valsartan): This medication is a newer treatment for heart failure and has been shown to reduce hospitalizations and mortality in patients with heart failure with reduced ejection fraction. It can be used in conjunction with other heart failure medications, but it is essential to ensure that it does not interact negatively with your other medications.

Given your concerns about potential drug interactions and the effectiveness of your current regimen, it is vital to communicate openly with your healthcare provider. Here are some steps you can take:
- Prepare for Your Appointment: Make a list of all the medications you are currently taking, including dosages and any over-the-counter drugs or supplements. Note any side effects you have experienced, particularly those related to your heart rate or blood pressure.

- Discuss Your Concerns: Bring up your concerns about the medications, particularly regarding their interactions and effectiveness for managing both AF and heart failure. Ask your doctor if there are alternative medications that may be more suitable for your condition.

- Monitor Your Symptoms: Keep track of your heart rate, any episodes of palpitations, shortness of breath, or other symptoms. This information can help your doctor make informed decisions about your treatment plan.

- Follow-Up: Regular follow-up appointments are essential to monitor your heart function, medication effectiveness, and any side effects. Your doctor may need to adjust your medications based on your response and any changes in your condition.

In summary, managing atrial fibrillation and heart failure requires a comprehensive approach that includes careful medication management. It is essential to communicate any concerns with your healthcare provider, as they can help tailor your treatment plan to ensure safety and effectiveness. Your proactive approach to your health is commendable, and working closely with your doctor will help optimize your treatment and improve your quality of life.

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