Which medication is preferred for rate control in atrial fibrillation associated with HFpEF?

Beta blockers are the preferred medication for rate control in atrial fibrillation, especially when it is associated with heart failure with preserved ejection fraction (HFpEF). These medications work by blocking the effects of adrenaline on the heart, leading to a decrease in heart rate and myocardial oxygen demand. This is particularly beneficial in patients with heart failure, as it helps to improve symptoms related to high heart rates and reduces the risk of worsening heart failure.

Beta blockers also provide additional benefits, such as improving cardiac function and reducing the risk of arrhythmias. They enhance the overall management of heart failure by decreasing the workload on the heart while allowing for improved cardiac output during exercise. Additionally, certain beta blockers like carvedilol and metoprolol have shown mortality benefits in heart failure patients.

In contrast, other medications such as amlodipine, oral nitrates, and hydralazine do not primarily focus on rate control in the setting of atrial fibrillation. Amlodipine, a calcium channel blocker, is not typically used for rate control in atrial fibrillation associated with heart failure due to possible negative effects on heart function. Oral nitrates primarily act as vasodilators and are not effective for controlling heart rate. Hydralazine can