I purchased an apple watch a couple of weeks ago and got an Atrial Fib alert with an average HR of 105. SO at that point I decided to visit my DR which sent me to get an ECG test done which confirmed the results from the alert. My Dr prescribed me 5mg of APIX twice a day and 5mg of BISO once a day. He has made me an appointment to see a cardiologist however, the soonest I can see him is Sept 5th? Isn't that nuts! Anyway, prior to getting the alert and seeing my doctor I did have episodes of being light headed once in a while over the last year or so however, I'm retired and don't do much so I attributed that symptom to being out of shape. I just turned 60 a few months ago and picked up my prescription today (haven't taken it yet). I suppose my question would be more of seeking advice? Little nervous to start taking these meds as I'm under the impression that once you start taking these types of meds that you can't stop taking them.
Any feed back on do's and don'ts would be appreciated.
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Just to clarify, APIX I assume means Apixaban, and, BISO means Bisoprolol. So, just what have you been told about these meds ? Fer instance, apixaban is an anticoagulant so that will protect you from a spin off from AF - which is stroke. Bisoprolol is a drug used for heart rate control ........ BUT ......... it has some properties which make it useful for blood pressure control too.
This leads into my next questions ..... have you had blood pressure readings undertaken by your GP .... curious as to what they were, if any.
When I was diagnosed back in Jan 2010 ( age 65 ) I was also put on an anticoagulant and Bisoprolol .......... all these years later I'm still on them and am now 79 .... no sweat, still work part time driving buses. Putting a patient on these two types of drugs seems to be the first, most direct course of action. DO NOT fear these drugs, they're to help you and to try and control your HR ............ if you do not take them as prescribed ... at your own peril. What is your fear about taking them for life ? I'd be much more afraid of not taking them and having a stroke caused by AF. You may not be on them for life, rather just on them until you see a cardiologist !! He'll give you the next lot of advice.
Last August I was switched from Bisoprolol to Nebivolol because of very belated side effects but they are the same type of drug, a beta blocker. You will initially get side effects from Bisoprolol but hang in there ..... if they are too bad, and if you are at the moment taking them in the morning ... get in touch with your GP and ask about taking them at night .... this happened to me and night time is no problem. Whatever you do though ......... its your call ..... do not faff around with them, start them, stop them, mess around with them - whatever. You either start them or you don't .......... if you choose the DON'T option ......... ??????????????? good luck to ya.
I assume from what you say you are in the UK ? Just curious if you are on any other medication, like Ramipril for high blood pressure.
This is all new to me, my regular doctor of 30 years retired last year and his replacement is a 30 year old just fresh out of school which doesn't make me feel to confident in him as he has done nothing in terms of test other then the ECG. No blood work at this point. You are correct...two meds are Apixaban and Bisoprolol. I am just nervous about potential side effects. I don't even know if I can take both at the same time? The Apixaban is to be taken twice a day so I'd assume one in the morning and the other in the evening and the Bisoprolol is once a day and so I assume in the morning which leaves to the question if it is ok to take both meds at the same time or should I give an hour or 2 between the two. I will be happy to get to see the cardiologist where I'd feel more confident to follow what he tells me, unfortunately I have a little wait till I get to see him.
Take bisoprolol at night is best,take with any other meds is fine.The watch has done its job,identified largely asymptomatic AF. Any GP who ignored this reading would be failing you.
We are the 'lucky' ones! Those people wandering around with undiagnosed AF ate a ticking stroke bomb. Many people a year are only diagnosed in an autopsy ...
The Apixaban is your protection. The bisoprolol is to keep your heart rate steady.
One tip,make it known you would take a cancellation appointment to see the cardiologist, might get you in sooner.
Bisoprolol can be taken at the same time but as it's once a day can be taken whenever you choose so long as its roughly the same time every day, i.e 24 hourly.
That sounds like first line treatment for AF and is a very common. As John explained the most important of those meds is Apixaban as a prophylactic treatment to reduce your risk of stroke which can be high. Did your GP discuss with you your risk of stroke? This is calculated by algorithms, there are several and depends on preference but a common one is CHADSVASC score which you can do for yourself online - mdcalc.com/calc/40/chads2-s...
Score 1+ and anticoagulants are really a must. Score 0 it is often personal choice.
As to stopping them, if you have AF anticoagulants are really then for life and there is a good evidence base now for their safety and efficacy whereas stroke ????? Not good for you health. I had a TIA when I came off anticoagulants after what I thought had been a successful ablations treatment and I hadn’t had any AF for 12months. My brilliant EP was not in favour and after the TIA I couldn’t get back on them fast enough so as far as Apixaban is concerned - probably for life.
Your GP should have done a Blood Test prior to you starting these meds, mainly for a baseline figure and in UK it is usual for GP to do blood tests every 6-12 months dependent upon age and fitness. I would return and ask for those to be done and ask for a CRP inflammatory marker also.
Keeping track of your BP is also important as is controlling - Biso is a beta blocker which will also have some affect on lowering BP. Many people do well on this drug, for me it is poison so I have refused it. You can have serious symptomatic affects from Biso, breathlessness, weight gain, feeling wiped out. Heart rate going too low (low 50’s or 40’s) but these symptoms often pass in a few weeks as your body adjusts. I would also caution than once you start on Biso you may have problems with symptoms of raised anxiety, especially if you stop.
In your shoes I would be reluctant to start Biso IF heart rate in AF was not elevated and you were none symptomatic AND your BP was stable and in normal range. One of the affects of AF is BP which varies widely. Normal BP = 120/80. If over 130 systolic you would be well advised to take something to help stabilise and lower BP. BUT I am not your doctor, don’t know your medical history or you or your lifestyle.
Waits for referral to cardiology are over 12 months here in my part of the UK unless you are an emergency and sounds like your AF would not be triaged as very urgent. I know Canada has a very different health system and it’s not always possible to seek an appointment privately in parts of the country, but if you are able, it can really be very beneficial as just having the conversation with a specialist can settle the anxieties which inevitably arise with a diagnosis of AF. See a specialist cardiologist who is experienced in arrhythmias, often called an Electrophysiologist or referred to in threads on this forum as an EP. Also in UK GP’s are limited to what medications can be prescribed so you would need to see a specialist for a treatment plan and the sooner you can be converted to Normal Sinus Rhythm the higher the chance of remaining in NSR.
Another really useful book detailing the types of treatments, lifestyle measures which help and blood tests which are useful to track is The AFib Cure - Dr John Day - who also has a blog with useful titbits.
Knowledge is potential power as to what treatments you can ask about and discuss with confidence with your doctors. This actually often influenced what you are offered I have found.
Ask any questions - a very informed bunch of people here with a wide range of experiences from many countries. Best wishes
Thank you for the reply, I have just taken my first Apixaban pill and I have less concern with this med then I do with the Biso. This new doctor of mine who is young and inexperience hasn't done any blood work as mention previously however, he did do a BP test in the office but as bizarre as this may sound, I didn't even pay attention to what he said in terms of numbers. I do believe he made a reference as it not being bad. The readings from my watch when I get afib alerts and I get them a couple of times a day are always with an average of 100 bps or higher so I would assume that would mean I have an elevated heart rate? SO with that said, I guess I would need to take the Biso. I ordered a blood pressure monitor so I can report back those findings soon. More research is needed on my end in respect to what results mean etc. lol UGH. Thanks again for the reply.
I’m good thanks, thankfully my episodes weren’t that symptomatic except when suffering with Covid or other infections anyway, I chose the ablation route on advice of my EP to hopefully stem the progression to persistent or more frequent episodes. I was the same as you with regard to starting meds that will probably be for life but I may be able to reduce or stop the Bisoprolol which will be discussed in my review next week.
If you are paroxysmal then you can get a good idea when you have episodes looking at your Heart Rate Variability history on your iPhone in monthly view. When in AF your HRV will spike high. The background checks do not alert every episode but if you’re persistent you will get more alerts. There is an AF history setting which turns off the alerts and is meant for watch users diagnosed with AF. I’ll add a link
I can’t offer much advice about the meds as I am just on apixaban myself, but would ask if there is a reason you don’t do much? Exercise in moderation can a great way to reduce afib episodes along with other lifestyle changes. A health condition like AF can be an opportunity to make a few positive changes.
Let's just say that for the pass 30 years I've been behind a desk and never got into any sort of exercising (although clearly I should have). Yesterday was my first day on apixaban and thus far although I've only started taking it, I am encouraged as I have no negative side effects from taking them......YET. I elected to start my Bisoprolol just before going to bed this past evening and found myself woken up to a mild headache and up 3 hours earlier then normal (5 hours sleep). So if that is the extent of side effects for Bisoprolol I'd be pleased however, I am certain this is just the beginning. lol
I had Afib, quite a run of it, had an echo done, no structural damage. Long story but I never actually got to see a cardiologist, first he said I had it and he would recommend an ablation, anti coags and a heart rate control. I sent him some Kardia readings which said Afib on them, he decided I didn't have it ? He never offered to prescribe any meds and somewhere along the line it was recorded I'd refused them, not true I just expressed doubt. I only occasionally have Afib now and I read that in itself won't kill you so despite never being seen by the cardiologist ( nearly 4 years since the referral) I decided I was happier to take the risk of being unmedicated. So far so good, I'll be 73 soon, I weight train and do yoga. I'm not prepared to pop pills daily for something that doesn't bother me that often. Personal choice of course.
It is your body and your choice and I think its good to question any doctor on any diagnosis and if you have doubt? Seeking a second opinion is probably your best option rather than ignoring any diagnosis or treatment offered. I will not pretend to know anything about afib because I don't! lol However, if I am diagnosed with any disorder, I owe it to myself and my family to investigate it further and trust the professionals on their recommendations. I have a grand daughter who is 8 years old, I want be able to be there when she graduates high school, gets married and so on and in my opinion ignoring treatment is just something that I am not willing to do although, I respect your decision.
If you have followed this forum long enough you’d appreciate that there are a lot of medical professionals advising patients who go from not being quite accurate to being completely wrong, trying to sort out which is which is the tricky bit. The medical profession are apparently all taught the same; despite time and experience proving that some of what they’re taught is no longer accurate or appropriate they will not listen or alter their advice, this exposes some patients to potential harm or worse, it is right to question because it’s our health and wellbeing at stake. We have the huge resource of the internet these days, one should at least try to verify that what you are being advised is right for you. These fora exist because there are a lot of unhappy sick people not getting the right treatment and also there are those who want to know more about their diagnosis, I think these days that’s no bad thing, knowledge is power.
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