An 83-year-old woman with a history of atrial fibrillation and congestive heart failure was admitted to the hospital after presenting with lightheadedness and palpitations secondary to atrial fibrillation with rapid ventricular response. This was her third admission for atrial fibrillation with uncontrolled heart rate in the past 6 months. Pharmacy records indicated she had not refilled either of her prescribed nodal blocking agents for several months. She was restarted on her reported home dose of metoprolol succinate at 50 mg daily and diltiazem 180 mg daily with prompt normalization of heart rate. She was discharged the following day.
Carroll C, Hassanin A. Polypharmacy in the Elderly—When Good Drugs Lead to Bad OutcomesA Teachable Moment. JAMA Intern Med. Published online April 24, 2017. doi:10.1001/jamainternmed.2017.0911