Jodi Whitaker

By

College: Medicine

UK Study Finds Commonly Used Heart Disease Drug Increases Deaths in Atrial Fibrillation Patients

Published: Nov 28, 2012

 

LEXINGTON, Ky. (Nov. 27, 2012) -- Digoxin, a drug widely used to treat heart disease, increases the possibility of death when used by patients with a common heart rhythm problem − atrial fibrillation (AF), according to new study findings by University of Kentucky researchers. The results have been published in the prestigious European Heart Journal, and raises serious concerns about the expansive use of this long-standing heart medication in patients with AF.

 

UK researchers led by Dr. Samy Claude Elayi, associate professor of medicine at UK HealthCare's Gill Heart Institute, analyzed data from 4,060 AF patients enrolled in the landmark Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. This analysis was intended to determine the relationship between digoxin and deaths in this group of patients with atrial fibrillation, and whether digoxin was directly responsible for some deaths.

 

“These findings raise important concerns about the safety of digoxin, one of the oldest and most controversial heart drugs,” said Dr. Steven E. Nissen, chair of cardiovascular medicine at the Cleveland Clinic. "Although considered obsolete by some authorities, digoxin is still widely used. A thorough review by the FDA is warranted to determine whether regulatory action is needed, including stronger warnings about the use of digoxin in patients with atrial fibrillation. “


Digoxin is extracted from the foxglove plant and it helps the heart beat more strongly, and at a slower heart rate. It is commonly used in AF patients and in patients with heart failure. However, it can be problematic to use successfully as there is a narrow dose range at which it is effective, and beyond which it can be dangerous.

 

Though digoxin has been used by physicians treating AF for decades, until now, there has been limited evidence demonstrating the effect of digoxin in patients with this condition. “Digoxin in AF patients has hardly been studied,” said Elayi. “The main prospective randomised controlled trials available with digoxin were performed in patients with heart failure and sinus rhythm, and routinely excluded AF patients.”

 

The results of the analysis found that digoxin was associated with a 41 percent increase in deaths from any cause after controlling for other medications and risk factors. An increase in deaths occurred regardless of gender or the presence or absence of underlying heart failure. Digoxin was also associated with a 35 percent increase in deaths from cardiovascular causes, and a 61 percent increase in deaths from arrhythmias or problems with the rate or rhythm of the heartbeat.

 

"Within five years of use, one additional AF patient out of six taking digoxin − compared to those not on digoxin in the AFFIRM trial− will die from any cause," Elayi said. "One additional patient out of eight will die from cardiovascular causes, and one additional patient out of 16 will die from arrhythmias.

 

“This study calls into question the widespread use of digoxin in patients with AF, particularly when used for controlling AF rate in a similar way as in the AFFIRM trial," Elayi said. “These findings suggest that physicians should try to control a patient’s heart rate by using alternatives such as beta-blockers or calcium blockers ,as a first line treatment.

 

"If digoxin is used, prescribers should use a low dose with careful clinical follow up, evaluate potential drug interactions when starting new medications, and monitor digoxin levels."

 

In addition, patients should also be aware of potential toxicity and see their physicians immediately in specific clinical situations, he said. For instance, if they experience increasing nausea, vomiting, palpitations or syncope, as those may precede arrhythmic death, Elayi added.

 

The researchers say that the mechanism by which digoxin increases deaths among patients is unclear. Deaths from classic cardiovascular causes - whether or not they are due to arrhythmia - can partly but not entirely explain it. This suggests there must be some additional mechanism that remains to be identified, said Elayi.

 

“Our study underscores the importance of reassessing the role of digoxin in the contemporary management of AF in patients with or without HF,” concluded the authors in their paper.

“There is a need for further studies of the drug’s use, particularly in systolic heart failure patients and AF – patients that would, in theory, benefit the most from digoxin.”

 

The full research paper is available at http://www.oxfordjournals.org/our_journals/eurheartj/press_releases/freepdf/prpaper.pdf

 

 

 Media Contact: Jodi Whitaker at (859) 257-5307

_dsc1296_2.jpg
January
 
 
 
 
1
 
Thu
2
 
Fri
3
 
Sat
4
 
Sun
5
 
Mon
6
 
Tue
7
 
Wed
8
 
Thu
9
 
Fri
10
 
Sat
11
 
Sun
12
 
Mon
13
Job Club: Job Search Strategies for the New Year: A 15 Day Action Plan
Tue
14
Bicycle Trivia
LNFS Presents: Hercules
Wildcat Wellness: Meditation
Wed
15
LNFS Presents: Dazed and Confused
LNFS Presents: Boyhood
MLK "I Have A Dream" Silent March, Vigil & Program
Thu
16
MLK Multicutural Org Fair
Fri
17
 
Sat
18
 
Sun
19
 
Mon
20
 
Tue
21
LNFS Presents: Mission Impossible 3
Wildcat Wellness: Meditation
Caregiver Support Group
Wed
22
LNFS Presents: Big Hero 6
LNFS Presents: Together With You (He ni zai yi ki)
Thu
23
LNFS Presents: Five Broken Cameras
LNFS Presents: Scott Pilgrim vs. the World
National Student Exchange (NSE) Info Session
Cultural Coffee Hour
Fri
24
Pershing Rifles Drill Meet
Welcome Back Students Swing Dance!
Sat
25
 
Sun
26
Career & Major Exploration Session @ 11 a.m.
Career & Major Exploration Session @ Noon
Career & Major Exploration Session @ 2 p.m.
Mon
27
Pinterest Party #1
Job Club: Using Networking to Find and Land a Hidden Job
Career & Major Exploration Session @ 1 p.m.
Career & Major Exploration Session @ 2 p.m.
Career & Major Exploration Session @ 3 p.m.
Tue
28
LNFS Presents: There Will Be Blood
Wildcat Wellness: Meditation
National Student Exchange (NSE) Info Session
Chapel Talk: Why The Church Should Support Marriage Equality
Wed
29
LNFS Presents: Mulholland Drive
LNFS Presents: Fury
Tattoo Exhibit
CatWatch Party #1
Thu
30
LNFS Presents: Clerks
LNFS Presents: Friday
Cultural Coffee Hour
Faculty Media Depot Opening Reception
Fri
31
 
Sat

Fri, 01/30/2015

Repeats every week every Friday until Fri May 01 2015 .
Fri, 01/30/2015

Mon, 02/02/2015

Reset Page