This is a long post - but I’m keen to hear any opinions.
My mother is 89 and was diagnosed with Atrial Fibrillation about a year and a half ago. She already had a pacemaker, which had been fitted over 10 years ago for sinoatrial disease.
At the time of her AF diagnosis she was put on 5mg Apixiban per day. She was already on 40mg Furosemide for high blood pressure, 30mg Lansoprazole for Acid reflux and 125mcg Levothyroxine for her thyroid.
At this stage, she was still quite a vigorous and independent woman. Her mobility though was poor because of severe arthritis in both hips, which she had been in denial about for many years. She finally saw a consultant and got on the waiting list to have one hip done. The hip consultant sent her to a cardiologist to check she was strong enough for the hip op.
At this point the Cardiologist put her on 2.5mg Bisoprolol per day. She found that hard to tolerate so they tried 125mcg Digoxin, which made her quite ill, so she went back on Bisoprolol at 1.25mg per day.
Today she is a shadow of her former self, completely exhausted most of the day, quite breathless, losing interest in all that she once enjoyed, becoming housebound etc etc.
I want to know whether there is anything else to be done? We get a lot from the medics of “well, she is 89 etc, her heart is not what it was etc” Maybe that’s true and I can’t decide if I’m just in denial about her decline, but I can’t help feeling there’s more life in her, her father lived to 96 and was fairly strong until 95.
I’m wondering if she might be a candidate for alternative treatment like a catheter ablation or cardio inversion, and why they haven’t been mentioned? Or even different drugs? Sometimes I think she’d be better off stopping all her medication!
Hoping someone can give me some ideas or share similar experience. Thanks.
Written by
mitchino
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Firstly it is very important to understand that any and all treatment for AF is ONLY about improving quality of life (QOL). It is also important to consider that nothing is without risk .
At 89 those risks are not small either.
The anticoagulant (apixaban) is given to help reduce stroke risk as AF makes us five times more likely to have a stroke than similar people. A few people may decide that therirlife style or general health makes anticoagulaation a bad idea. For example if somebody is prone to falls then a doctor may think twice before prescribing it.
Bisoprolol being a beta blocker is intended to control the heart rate whilst in AF (by the way is your mother in permanent AF or paroxysmal (comes and goes)?).
With a pacemaker, heart rate should be controlled upwards from too slow by the PM so whilst keeping the rate from rocketing the bisoprolol should not be able to reduce it below PM fixed rate. Has she had a PM clinic check recently to see how much help she is getting from the PM? That said many people do find bisoprolol turns them into zombies but 1.25mg is about as low as it is possible to go. Whilst not medically trained here so shouldn't advise on drugs. one does wonder if it is worth taking this if QOL is so low.
I do suggest that you might think about having a seond opinion even if this means having a private consultation with another caradiolgist, preferably an electrophysiologist.
I can just about tolerate .65 mg a day but my cardiologist has written to my GP to change me to Nebivolol as I am sure even that liw dose makes my asthma worse.
Im guessing its the betablocker affecting her energy. It is a personal decision, I would discuss with her that it is her right to refuse any or all treatment. Sounds like she was getting along ok until they tried to switch things up. My mom was diagnosed with permanent a fib at 89ish, she took anticoagulant until she was 95 and risk for falling too great so we stopped it. She already had a pacemaker. She stayed pretty active and died at age 97. Fortunately she didnt need any betablockers or rhythm meds.
I would suggest a private appointment with a geriatrician recommended by her GP. In my experience, the majority of specialists are not trained, capable of or interested in providing a holistic assessment of multiple pathology in the very elderly.
Cardioversion and ablation would be inappropriate in my opinion. Do you think she might be taking too large a dose of thyroxine?
Cardioversion is certainly the lowest risk, and if lucky could restore her to NSR for a period of time. Does she feel worse when in Afib? If not then the risk /benefit of just apixaban to prevent stroke need to be judged. Any beta blocker would have possibly severe effects on her energy level. If ejection fraction is low then the Afib could be sending her into heart failure in which rhythm control would be necessary.
I agree with all the above, I was on same B.blocker knocked me off for weeks till I got use to it, caused my already low blood pressure to be even lower, totally agree about a geriatric consultant, they look at the whole person, and quality of life, excellent suggestion,
If mums AF is slow, an anticoagulant maybe enough.
I was 55 when I was put on 1.25mg bisoprol and every tablet put me to sleep after 40 minutes, I woke up 4 or 5 hours later feeling , well "drugged" is the description, pain in my arms and chest, hardly any exercise tolerance, and so tired.
If your mother's response to the bisop Is the same as mine and she is 89 I am not surprised at her state. Some people do not tolerate bisoprolol . I stopped after 7 days and was put on Atenolol another beta blocker. This was much better but still lousy. My GP decided i did not tolerate beta blockers and put be on verapamil, a calcium channel blocker. Almost back to normal! Was on that 20 months very minor side effects.
I am not medically trained, just my experience, but suggest you get your mother's doctor to switch her to other beta blockers or calcium channel blockers to see if it improves her . It was easy for me to see , I was perfectly healthly running 6 miles in 48 mins one day , diagnosed afib, totally asymptomatic, given the bisop, can't run 100 yards the day after!
The cardiologist was trying to help. If it doesn't help, why take it? (Has it enabled her to have her hip problems sorted?) It is definitely possible to be 'over-medicated', especially when elderly.
Based on my personal experience with Bisoprolol at the age of 64. I would seek a second opinion. I was doing well with my rehab fitness classes and weight loss after a stroke but after being prescribed this beta blocker I could barely climb the steps to my front door I was so exhausted.
1.25mgs bisoprolol (prescribed by GP) left me feeling like I was walking in mud. I’m 70. I was told to stop taking it by cardiologist. I asked twice if I should wean off the tablet. No, it’s only a small dose. However, I know now I definitely should have been weaned off it so ask or look up advice on stopping this tablet. Quality of life is the most important thing. Best wishes.
I've nothing really to say about mitchino's message that's not been covered already, but I would perhaps warn against assuming Bisoprolol is the culprit here because it has been with you. Doctors are surprised now when I tell them I was started off on 10mg of Bisporolol a day when I was first prescribed it in 2008 and I've been taking that dose ever since. Apart from a kind of muzzy, gentle, headache every day, I can't say I've had any side effects from it and, although I accept AFib is a chronic, progressive condition, I'm pleased to say that mine seems to be proceeding very slowly,
Thanks for the many replies. Had the doctor over to see mum this morning and I relayed some of your opinions - she agreed to take mum off the Bisoprolol for now to see if it makes any difference.
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