Which medication is preferred for rate control in a patient with heart failure and atrial fibrillation?

In patients with heart failure and atrial fibrillation, the preferred medication for rate control is metoprolol succinate. This formulation of metoprolol is a beta-blocker that not only helps control the heart rate but also offers additional benefits for heart failure management. Metoprolol succinate is specifically indicated for chronic heart failure and has been shown to reduce morbidity and mortality in these patients.

The extended-release formulation allows for stable blood levels and a once-daily dosing regimen, which enhances adherence to the treatment plan. Additionally, beta-blockers like metoprolol succinate can improve left ventricular function, making them particularly beneficial in patients with heart failure.

Other options, while they may also be used for rate control, do not have the same level of evidence supporting their use in heart failure. For instance, diltiazem is a calcium channel blocker that can be effective in controlling heart rate but may not be the first choice due to its potential to worsen heart failure in certain patients. Digoxin is another alternative, particularly in cases of heart failure with reduced ejection fraction, but it typically does not provide the same level of rate control as beta-blockers in the context of atrial fibrillation. Thus, metoprol