Enhanced efficacy of bisoprolol and digoxin combination in elderly patients with atrial fibrillation

To investigate the effect of combining bisoprolol and digoxin on cardiac function in elderly patients with atrial fibrillation (AF).

A retrospective analysis was conducted on the clinical records of 100 elderly AF patients treated at the Second Affiliated Hospital of Hainan Medical University from April 2020 to April 2023. Forty-six patients treated with digoxin alone were assigned to the control group, while the remaining 54 patients treated with bisoprolol in addition to digox comprised the study group. Outcome measures included cardiac function-associated indices (left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular ejection fraction (LVEF)), ventricular rate at rest and during exercise, myocardial energy metabolism (plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatine kinase (CK)), and psychological status prior to and post therapy, and the overall response rate and adverse reactions. Multiple logistic regression was performed to identify independent risk factors for an unfavorable prognosis.

After treatment, LVEDD and LVESD levels significantly dropped in both groups (P<0.01), and LVEF level increased significantly (P<0.001), especially in the study group (P<0.01). Ventricular rate at rest and during exercise also decreased significantly in both groups (P<0.001), with a more pronounced effect in the study group (P<0.001). NT-proBNP and CK levels greatly decreased in both groups (P<0.001), especially the study group (P<0.001). The study group presented a notably higher overall response rate compared to the control group (P=0.011), but no significant inter-group difference was observed in the total incidence of adverse reactions (P=0.547). Both groups showed significant reductions in SAS and SDS scores after treatment (P<0.05), with a more substantial improvement in the study group (P<0.05). Logistics regression analysis identified comorbid diabetes mellitus (P=0.025; OR=6.086; 95% CI=1.250-29.638), comorbid hypertension (P=0.007; OR=7.059; 95% CI=1.728-28.842), New York Heart Association classification (P=0.023; OR=0.197; 95% CI=0.049-0.800), and treatment modality (P=0.020; OR=5.911; 95% CI=1.326-26.338) as independent risk factors for unfavorable prognosis.

In contrast to digoxin alone, combined application of bisoprolol and digoxin is more effective in treating elderly AF patients. The combined treatment can significantly improve LVEDD, LVESD, LVEF, and ventricular rate without increasing adverse reactions, making it a promising approach for clinical application.