By vgreene, 15 January, 2015 If BB/CCB failure/intolerance, use dig/combos:<sup>13</sup> Dig controls resting HR in HFrEF [I/C]. Combine BB w/ other drugs, incl. dig; titrate to avoid bradycardia. Dig may be combined w/ BB or CCB [IIa/B] incl. for HF pts (avoid CCB if HFrEF) [IIa/B]
By vgreene, 15 January, 2015 BB/CCB (diltiazem/verapamil)<sup>13</sup> is 1st line [I/B]. If COPD, CCB [I/C]; if hyperthyroid, BB [I/C], if can’t be used, CCB [I/C]; if systolic HF, BB. Resting goal HR ≤80 [IIa/B]; if no sx & preserved LV systolic fxn, consider lenient ≤110 [IIb/B]
By vgreene, 15 January, 2015 Anticoagulate<sup>10,12</sup> based on stroke/bleed risks, renal fxn, pt preference [I/C]
By vgreene, 15 January, 2015 If postcoronary revasc (PCI/surg): reasonable to add clopidogrel 75 mg/day (not aspirin) to anticoagulant [IIb/B]
By vgreene, 15 January, 2015 If drug rate control inadequate/sx persist, use rhythm control.<sup>9</sup> If drug tx inadequate and rhythm control not achievable: AV-node ablation<sup>9</sup> + pacing [IIa/B]
By vgreene, 15 January, 2015 If HF w/ rest/exercise HR not controlled w/ BB, CCB (in HFpEF) or digoxin (alone or combined): consider amiodarone<sup>8</sup> [IIb/C]