I take 2.5 mg of bisoprolol daily and in normal sinus rhythm a steady heart beat of 65 bpm. I've had three 40+ hour episodes of AF so far this year and was admitted to A & E during last episode. I had increased bisoprolol dose to 3.75 twice a day while in AF . The doctor in Same Day Emergency Care told me to stay on 3.75 twice a day now and this has been confirmed by my Arrhythmia nurse. I feel very reluctant to do this as most of the time I feel ok. Has anyone else had their bisoprolol dose increased by so much?
Another bisoprolol query: I take 2.5 mg... - Atrial Fibrillati...
Another bisoprolol query
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LizLancashire
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Not only do I not see the logic, but I even question why you need bisoprolol at all, with the exception of bringing your heart rate down during an afib episode and for a few weeks afterwards while the heart calms down.
Bisoprolol is a very weak anti-arrythmic and any anti-adrenergic or other heart calming rewards have to be weighed against the side effects of the drug. If I were in your position, I'd ask for a trial off of Bisoprolol completely (you will need to be weaned) and see if you are: (1) Better; (2) The same; (3) Worse.
I had afib for over 40 years and didn't start taking beta or calcium channel blockers on a regular basis until I needed them for safety reasons since I started Flecainide. I did take them, however, to bring down my rate during an afib episode and for a few weeks afterwards.
I'm sure the same day Emergency Care Doc is well meaning, but sometimes they just throw drugs on top of drugs with nothing evidence based behind it.
Jim
Thanks Jim
Thanks Jim, food for thought. Hearing about every experience is helpful in making a decision.
Educate me on Arrhythmic Nurses in UK. Are their recommendations reviewed by an EP or cardiologist or have they completed requirements to make a recommendation without review ?
You must have been originally been prescribed Bisoprolol to maintain your sinus rhythm and excellent heart rate which it has done.
However, has 40+ hour episodes over a 4 month period been the norm ? And the last requiring an A&E visit. 10+ hours a month seems like alot. Please keep in mind afib is often a progressive disease.
The A&E doctor may have seen something on your EKG and history that warranted the dosage increase.
May want to get a second opinion. And insure you take an anticoagulant.
Best to you in managing your health.
I understand Arrhythmia Nurses are qualified to make a recommendation but maybe someone on here knows more. I must say I was very pleased to be allocated one after 12 years of AF.I was put on Bisoprolol originally by EP.
I also take edoxaban.
Previously my episodes of AF have never been longer than 12 - 14 hours so it has been a shock to "progress" to 40+ hours.
I've agreed to a second ablation which I was very reluctant to go through again after a tamponade during my first one.
Yes ,I too have no idea what an Arrythmia nurse is - we do not have them in South Africa - can she prescribe cardiac drugs.? It does appear to me that there are nurses doing diagnoses that I would expect to be carried out by doctors. The last time I was in the UK visiting my family, I picked up a chest infection, and was seen by a nurse at my sister's surgery. Despite telling her I was an AF sufferer she prescribed an inhaler (I'm asthmatic) that my Cardiologist had removed from my medications which is contraindicated for AF, as soon as I was diagnosed. I did not use it. Home nebulization such as I do at home if my asthma has a bit of a flare up, was not allowed as she said that it is only done in hospitals, and the antibiotic she prescribed, I had previously only seen prescribed by my vet when my dog had biliary fever (caused by a tick bite). I was still suffering when I got home and immediately saw my GP, she smiled when I told her what antibiotic I was on as she said it is generally prescribed for acne!
There has been a dreadful case recently in the UK of a young man called David Nash who died of a brain abcess after failing to get a face to face appointment with a medical practitioner. He had four telephone conversations- two with "advanced nurse practitioners" . One of these diagnosed him with an outer ear infection and prescribed drops. He actually had a middle ear infection that untreated led to the brain abcess . He was 26. The conversations were recorded and one with the second nurse practitioner was played on Newsnight. By this time he was slurring his speech and reported severe neck pain , fever for more than 10 days and sinus pain. She seemed to have no knowledge of his previous phone consultations and from her questions and responses to him seemed way out of her depth. If she was an "advance" NP I dread to think how bad the ordinary ones are. She decided he had a flu type illness and prescribed painkillers. 2 days later he was dead. To be fair this happened during covid when many GP surgeries seemed to shut up shop altogether and people were discouraged from going to A&E in the UK .Nurse practitioners are still doing the job of doctors in many GP surgeries because there are not enough doctors. It is bad enough not getting face to face appointments with GPs but to be fobbed off with telephone consults with unqualified people is appalling. I am sure that some nurse practitioners are highly trained particularly the specialist ones but there seems to be wide variation.
Very sad case
My experience was towards the end of 2019 before the Covid 19 was even mentioned!
Arrhythmia nurses do have a specialist training. They are there to assist in the management of patients with ongoing heart rhythm conditions and supporting them post procedures. They do not prescribe but they can advise. They are also a useful hot line to your EP or cardiologist e.g. I was worried about starting treatment for hypothyroidism because levothyroxine is known to increase HR if you've been subclinical for any period of time. I was able to ask my arrhythmia nurse to run this past my.EP and got an answer quickly. The arrhythmia nurse usually has their own work.mb and you can email,.text or call.them.directly.
Mine has been great at responding to me quickly when I get in touch with a query or plea for help when in AF.
I see, but can't you just phone direct to your specialist if you have queries and leave a message with his receptionist if he's busy so he can phone you back? Is it mandatory that you go through the nurse?
Much quicker to go through the nurse. My EP told me it's the best route.
Link for description of Arrhythmia nurses in Leeds.They totally take over your care from initial diagnosis to decisions on treatment.They can make a decision on CV & recommend & refer to EP for ablation. leedsth.nhs.uk/a-z-of-servi...
hi liz
On a visit last week to hospital with my AF the doctor decided to up my bisoprolol from 2.5 mg to a big jump to 10mg !!! So far I’ve had the shakes , nausea , and headaches but the doctors said give it 2 to 6 weeks to get into my system …….., I shall wait and see
Hugs barb 😀
That's interesting Barb, a very big jump. I'd like to hear how you go on and if the side effects stop.Thanks
Liz
hi liz I will keep you informed 😀
My husband got so bradycardia with heart rate of 42 on 5mg of Bisoprolol. Curious what your resting rate is now.
Surprisingly it hasn't changed much. A steady 63/64 bpm.
Sorry Lenaropes, should have said I've only increased it to 2.5 twice a day so far.
I went from 1.25 to 3.75, to 5.00mg. Awaiting a cardioversion which I hope sorts me out as I feel lousy
I was diagnosed with ( mostly , after first horrible episode ) asymptomatic Paroxysmal Afib 6 years ago and was put on 2.5 mgs Bisoprolol. This suited me until 2 years ago when I had a spell of Tachycardia when the GP upped that to twice daily. All good. 9 months later more Tachycardia and dose increased by cardiologist to 7.5 mgs divided into 2 daily doses. That didn’t help and GP increased it to 5 mgs morning and night. No Tachycardia since, but I do have little runs of Afib at a heart rate of about 65. Bisoprolol does suit me although I do feel tired/lazy quite a lot. My cardiologist says a lot of that is probably the Afib but he is happy my heart rate is good. I know Bisoprolol is for rate control rather that Rythmn control and in my case, I think the cardiologist is keen to save my heart from stress as I have a couple of leaky valves. What is your heart rate when in Afib ? The medics do seem more concerned with the rate than the rythmn. Also, if you tolerate Bisoprolol, for a lot of people it is the mildest drug. If it doesn’t suit you, you would know, even on a small dose I believe. I think you would be quite in order to query your dosage and get a conversation going about what the medical team’s expectations are for your individual case. I feel that sometimes, because they can see your overall situation plainly before them, in all their notes and test results, they forget that we only see it through a tiny pinhole, so to speak. I hope you get explanations for your concerns and your unpleasant Afib episodes get controlled.
Annie.
Thank you Annie. My heart rate in afib is 151 bpm. I've been fine on bisoprolol for a number of years at 2.5 mg with NSR of 65 bpm and afib episodes every couple of months lasting 12 - 15 hours. I've had 3 episodes this year though of 40+ hours. The Same Day Emergency Care Dr and my Arrhythmia nurse want me on 3.75 mg bisoprolol twice daily now but settled on 2.5 twice a day to start with.
Your heart and your doctor are unique as he or she has a far better knowledge of what is happening to it than anyone else. On that basis, I would never gainsay a doctor's recommendation. However, often, bisoprolol and other treatments for AF are given only to help relieve symptoms of the arrhythmia, rather than to protect the heart from future deleterious changes. I would ask your doctor which of these two different scenarios applies to you and, if the former, then it might be possible, given the low frequency of your AF episodes, to take a tablet on an as-needed basis (a "pill in the pocket"), perhaps alongside a lower daily dose.
Steve
Arrythmia nurses are specialist nurses who work very closely with Electrophysiologists. They are often funded by charities or companies rather than being directly employed by the NHS. Arrythmia nurses run their own clinics and assist in Cath lab during ablation procedure. In my experience are able to triage patients so that the most urgent cases get fast tracked to see the Electrophysiologist with whom they work and help with follow up appointments. They have special prescribing training so that they, like practice nurses, are able to advise and prescribe. Patients’ notes would be supervised by the Electrophysiologists I believe.
The nurses that I have had contact with are exceptional and allow the Electrophysiologist to see the more patients. There is currently a desperate shortage of Electrophysiologists and an avalanche of patients who would just not otherwise be seen without Arrythmia nurses.
There are specialist nurses for just about every speciality, especially for Cancer, diabetes, Parkinson’s, Osteoporosis and General Practice.
Nurses in UK are often very highly trained and can hold Doctorates and Consultant status in their own right - Dr John Cambell being a well known example on You Tube.
As an example bhf.org.uk/for-professional...
Thank you CDreamer. I feel I've been so lucky to be allocated one recently after 12 years of AF. It's hard coping with episodes living alone but she replies to my queries instantly.
That’s great and sometimes that’s all you need, some reassurance.
They can also be pretty useless- see my reply to pusillanimous above. Anybody who listened to the replay on Newsnight of the conversation David Nash had with the NP just 2 days before his death would be very put off having to deal with one. Rather than detecting that this was a person who needed to be seen urgently she even cancelled the blood tests he was due to have in person at the surgery that day ( where his appearance should have alerted someone to the fact that he was dying) and insisted he retest for covid before coming. John Campbell was a nurse educator. I would imagine that the majority of nurses that have doctorates and /or consultant status are to be found in the higher echelons of nursing administration not in GP's surgeries.
I have to agree with you, whatever training these nurses receive , it does not trump the training of doctors ,and while I accept having a practice nurse dressing a wound or placing the leads for an ECG, I expect involvement from a qualified doctor, i.e. to prescribe the correct anti- biotic, and tetanus vaccination in the case of a wound, and to have the patient in front of him/her while he/she delivers an accurate interpretation of the tracing in the case of an ECG or lung function test. I agree about placing the more qualified nurses in admin. I know a young lady, previously involved in midwifery, who studied for further academic qualifications, and is now involved in admin, at an NHS hospital and no longer practically involved in the field in which she is needed.
All I can say is that my experience has been excellent on various levels and I’ve had terrible experiences of doctors along with excellent ones.
Maybe if the NHS looked after their staff better they would look after us better?
consultant nurse in our previous GP practice was a shareholder in the practice.
But wasn't this a generalist practice nurse? Or have I misunderstood? They wouldn't be as skilled or.knowledgable as one of the specialist nurses. One or two of the practice nurses we get at our surgery are rubbish!
You are correct that the GP nurses wouldn’t be as specialised as the Arrythmia nurses that work with the EPs. Most GP practices will have a number of Practice Nurses at Sister level but the lady I saw for my AF at the GP clinic was a general Consultant nurse with a Doctorate and was a shareholder in the practice. She was very highly qualified and she supervised my ECG’s and annual Healthy Heart although it was usually one of the practice nurses who actually took the appointment. She was able to prescribe and refer for a number but not all conditions. I believe she has now retired but I have met several nurses at Consultant level which I believe is Band 8-9. A practice nurse would be Band 5-7 I believe?
Yes but my reply was to Pusillanimous who spoke about incompetent treatment from a nurse at his sister 's GP's surgery . Both nurses in the case of David Nash were described as "advanced" nurse practitioners . There was also incompetence from one of the doctors involved who treated Nash for a urinary infection because he complained about blood in his urine despite him having no other symptoms of a UTI and them not being common in young men. Nobody seems to have joined up the info given in the various phone calls and given any serious thought as to what was really the matter with this poor man. A real example of the dangers of telephone consultations.
Ah, thank you for explaining! These threads get complicated and one responds to the email alert sometimes without checking the route! Apologies if I was trigger happy.
And I agree re telephone consults. Things not necessarily logged and our GPs and practice nurses so overstretched they don't join up the dots. Whereas if the patient was physically in the room, they'd SEE signs they could ask about.
Exactly. I suppose video calls would overcome those a bit but the doctor would still not be able to physically examine the patient. I look awful on videos anyway and there might be a tendency for dismissing people looking bad as effects of being filmed. The system in the UK seems broken with only those with money having really quick access to care. Part of the reason why we won't set foot there now.
Hi Liz. I am on 5mg Bisoprolol twice daily and have not experienced any problems. I am asymptomatic but do get breathless on exertion.Hope you get the answers you want soon.
Thank you Daisyblu, that's good to hear.
Hi Liz, when you are at home with drugs sometimes you have to monitor the effects yourself , and maybe slowly adjust the dosage to suit yourself , you know best how you feel, but maybe consult with doctor as well, if one bisop per day kept your rate down i dont see the need for more, but monitor carefully.
Thanks for the advice Tomred. I'll monitor carefully.
My cardiologist thought that 7.5 mg blsoprolol was very high and reduced my dosage to 5 without noticeable effects. .
Thank you Pindarus, that's interesting.
Well, I am not a fan of Bisoprolol, it makes my HR go low when asleep and if I’m sitting. I was on 2.5mg x1, I reduced it to 1.25 mg and the only took 1.25mg every other day due to it making my hr go below 60 as low as 48 at night mainly. Yes I know, everyone says that’s not low, but it IS for me and I hate it, wakes me up. Been having problems recently with stress and PAF, advised to take it more regularly and guess what, hr is worse for longer and I getting lightheaded and dizzy just turning over in bed!!
I am under a consultant 🙄
It's interesting all the varied effects it has on people. I'll see how I am on 2.5 twice a day.
hi Liz, I’ve been in sinus rhythm since my cryoblation a year ago and had my Bisoprolol reduced to 1.25mg/day. I had a Zio patch fitted for 14 days a few months ago and it showed me having eptopic beats a couple of times a day. My cardiologist said it would be best to stay on my low dose of Bisoprolol, as it helps suppress the eptopic beats. I went along with this, as I’m also on low dose spirolactone, and when I tried coming off it, I became a bit symptomatic after a few days, so went back on it…
It would be interesting if anyone has had similar experience….
hi Liz. I had paroxysmal AF for over 4 years and went into permanent AF just over a year ago. My GP increased the Bisoprolol which I was on from 2.5 to 5mg and so far all has been well. I have no problems being on Biso unlike some people, hope you will be okay too.
Thanks pwoody, that's encouraging. I wondered if I was moving to permanent AF as my episodes are getting longer.
I wondered this from your report. My.brother is now in persistent AF and his dose was upped from 2.5 once a day to 2.5 twice a day. He's doing fine on this. Gets a bit tired and breathless sometimes but otherwise isn't bothered by his AF. We know he's in persistent AF because I encouraged him to buy a Kardiamobile and it always shows him as being in AF.
Hello again Liz. Might seem strange to say but I much prefer being in permanent AF, to be quit honest I don’t know 🤷♀️ have got it. There is not that dread of waking up in the middle of the night with an episode which makes you feel very rough for a couple is days. Mine is well controlled by medication and I do all the things I normally do, but pace myself which I did anyway as I am almost 79. Hopefully if you go into permanent AF you will feel the same as I do. Take care.
That does sound hopeful. I’ve read the same comments from quite a few people in permanent AF. I'm nearly 79 too so pace myself anyway.
I have a kardia so can see I'm not in persistent AF yet but wondered if I was heading that way with my episodes getting longer.
Hi
I had my bisoprolol increased as Metroprolol gave me186 avge H/R DAY.
But even slowly increasing it to 10mg (5mg AM and PM) my resting heart was
156 avge H/R DAY.
A private heart specialist introduced CCB Calcium Channel Blocker Diltiazem 180mg
I dropped 105 H/R minute!
Twinked I take Diltiazem 120mg AM and Bisoprolol PM.
They both help with H/R although CCB better on control, BP BB Bisoprolol betterand both rythmn.
But in 2019 Sept I was diagnosed STROKE with AF and 4 days in hospital diagnosed with Thyroid Cancer. 4 months later cancer removed but heart did not revert to normal syn. Rapid and persistent.
AM 123/68. 62-88 H/R. PM. Evening 132/80. 88 H/R. Night 47 avge.
Controlled is most important.
Twinking your meds is important and the higher may be too much so that it needs bringing down again.
A great % of AFers find that episodes get closer and join up. Your heart sp is trying to
prevent that.
Cheers JOY. 74. (NZ)
Thanks Joy. That's quite a journey you've had. I hope you stay well now.
Hi
Thanx.
With Thyroidectomy for cancer removal, I rejected RAI Radio Active Iodine and Suppression of TSH.
On the Low Risk Register, 2 years later Triage Teams and Surgeons confess that Low Risk patients do not now be forced into the above!
cheri JOY. 74. (NZ)
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