Hi all, My dad is in persistent AFib. He was started on Digoxin 125mg after diagnosis of heart failure. He saw an EP and was additionally prescribed Bisoprol 2.5mg last week. Today is day 6 of him taking Bisoprol. He has been feeling slightly breathless from just walking around in his apartment/flat. His ejection fraction was 40-45%
My profile has all the details of my dad's condition.
Should I be concerned?
I saw this article which is worrying me but I don't mean to alarm anyone. 'Combination therapy of beta-blockers and digoxin is associated with increased risk of major adverse cardiovascular events and all-cause mortality in patients with atrial fibrillation: a report from the GLORIA–AF registry'. Published on 23 May 2024.
I would say that your father will slowly improve is my experience of this from closely following a friend's path out of a similar diagnosis. It is 125mcg of digoxin by the way, a tiny dose that should be very safe. Your father is lucky to have such a caring daughter but he is being treated properly by the sounds of what you write, so I would try hard to worry less or your own health will suffer.
I see from your notes that he also has bradycardia, and likely associated low BP, which the drugs will reduce further, I would guess. This will reduce his heart's ability to perfuse all the organs well with oxygen, including itself - hence the symptoms. Add in bisoprolol and there will be a worsening of those.
However, beta-blockers are now, and apparently against all previous received wisdom, deemed to be a gold standard way to treat HF. His current breathlessness could be a result of whatever is causing the heart failure and this might be made worse by the drugs - but the drugs also are given to extend life. It seems that it is always a balance with this condition.
His HF could be from the heart itself, and be from cardiomyopathy (i.e. weakened heart muscle), and so be left-sided or from COPD (which you haven't suggested, though) and be left- or right-sided, as with my friend.
Hi there, he doesn't have bradycardia and low BP. His pulse can go low occasionally so I should clarify that on my profile.
However thanks for the advice as it makes sense that so many things can have that effect on the heart. I think we just need to give it a few days and contact cardiology unit I'd things don't improve.
Nobody on the forum can comment on the specifics of your dad’s medication, particularly when the combination was prescribed only last week by his EP.
A piece of research can inform, regarding large population groups, but the EP has all the specific information about your father’s case she needs to make the very best judgement.
So no you don’t need to be concerned. And if you are, you need to email your dad’s EP.
There were results from a more recent study ( 2023) that showed that the use of both digoxin and a betablocker showed no significant difference in the risk of patients with both afib and heart failure returning to hospital in comparison to using just a betablocker or digoxin.Although there can be some risks in some patients another study showed that the combined therapy gave a better 1 and 10 year outcome for people with an ejection factor of 40-45%.
One reason you father could be becoming more breathless could be that he is still recovering or suffering with his symptoms.
I know he's also struggling with getting his iron levels up and might have problems with other nutrients ( I don't know if these have since been tested) Anaemia can also cause breathlessness.
The only thing any of us could recommend is that you ring his cardiac unit and let them know about the breathlessness and ask if your father might need a different dose , or to get a different betablocker or just use digoxin alone and ask if she can get a check up with them or the GP to make sure things are ok.
Thanks so much. That is very sound advice. I will give him a couple of days to get used to the medication and approach the cardiac unit. It's always great to get your perspective, thanks.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Digoxin 
Bisoprol and Losarten
Problems with Digoxin
Digoxin
