A 72-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) and chronic atrial fibrillation presents for routine follow-up. He reports persistent palpitations and occasional dyspnea. His current medications include carvedilol, lisinopril, spironolactone, and furosemide. His rhythm is atrial fibrillation with a ventricular rate averaging 95 bpm. His LVEF is 30%. What is the most appropriate next step in managing his atrial fibrillation?
✓ Correct Answer: Option B
For atrial fibrillation in patients with HFrEF, rate control with a beta-blocker is the primary strategy. Increasing the carvedilol dose is appropriate to improve rate control and reduce symptoms before considering other agents or rhythm control strategies.