Digoxin and mortality in patients with atrial fibrillation. Pdf digoxin in heart failure and cardiac arrhythmias. Digoxin has been shown to reduce heart failure hf hospitalizations with no overall effect on mortality in hf patients. Mechanisms, manifestations, and management of digoxin toxicity.
The effect of digoxin on mortality and morbidity in. Sympathoinhibitory responses to digitalis glycosides in heart failure patients. In patients with hf with reduced ef, digoxin augments cardiac output co and reduces pulmonary capillary wedge pressure without inducing potentially hazardous increases in heart rate or decreases in blood pressure 10,11. Notify the provider if the heart rate is less than 60min in adults, 70min in children, or 90min in infants. Food and drug administration approved digoxin in 1997, the guidelines currently offer. When the left ventricular ejection fraction is less than 40% it is termed heart failure with reduced ejection fraction. Explains digoxin may improve symptoms and lowers chance of going to hospital. The effect of digoxin on mortality and morbidity in patients. Digoxin is the oldest cardiac drug still in contemporary use, yet its role in the management of patients with heart failure hf remains controversial. In patients with heart failure due to systolic dysfunction and af, digoxin cardiac arrhythmias due to digoxin toxicity view in chinese cardiac glycosides digitalis preparations including digoxin and digitoxin are used clinically in two situations. You can help by taking your medicine as your doctor tells you, and by following your eating and exercise plans. Pdf digoxin in heart failure and cardiac arrhythmias researchgate.
Most people will likely be maintained on a dosage between 0. Hf with reduced ejection fraction hfref and hf with midrange ejection fraction hfmref in patients with hf, a diagnosis of hfref is generally confirmed. In contrast, digoxin is an established following conditions. Download now pdf highrisk heart failure patient identification checklist. This prescription drug works by blocking a certain enzyme in the body, allowing the heart to be more efficient at pumping blood throughout the body. To test the hypothesis that the effect of digoxin on outcomes in. On the clinical use of digitalis with reference to its. Our heart failure guidelines algorithm makes it easy to understand and apply the latest, evidencebased treatment guidelines. There was no substantial evidence, however, suggesting that the use of digoxin improved longterm outcomes in patients with heart failure. Digoxin is among the oldest cardiac drugs still in use, but its history has been marked by controversy. Therefore, monitoring free digoxin is not indicated for patients with uremia, liver disease, or any other pathophysiological conditions that may cause hypoalbuminemia. It strengthens the force of the heart muscles contractions, helps restore a normal, steady heart rhythm.
Therapeutic use treatment of heart failure, dysrhythmias atrial fibrillation, and can reduce manifestations. The higher doses needed to achieve the desired therapeutic effect could escalate to toxicity and cause sudden death. Lanoxin, digox, digitek, cardoxin the following information is not intended to endorse any particular medication. Unlike other interventions for heart failure, except cardiac resynchronisation therapy, 8 digoxin increases systolic blood pressure. Digoxin in heart failure and cardiac arrhythmias the. Heart failure is often due to myocardial dysfunction and is broadly classified by left ventricular ejection fraction. The underuse of digoxin in heart failure, and approaches. Amitava dasgupta, in clinical challenges in therapeutic drug monitoring, 2016. This report will help you understand and invest in the steps you need to take to keep heart failure in check. The underuse of digoxin in heart failure, and approaches to. The role of digoxin in the management of heart failure was clarified by a number of welldesigned randomised placebocontrolled clinical trials in the 1990s. Teach parents or caregivers that changes in heart rate, especially bradycardia, are among the. Youll get guidance for monitoring symptoms, for sticking to your doctors.
The majority of clinical trials published since 1980, most of which examined patients with new york heart association class u and in congestive heart failure, indicate that digoxin with or without reduces the morbidity associated with congestive heart faitere, particularly m patients with more advanced symptoms and ven tricular dysiunction. The digitalis investigation group dig trial, a randomized, doubleblinded, placebocontrolled study evaluating the efficacy of digoxin therapy for patients with heart failure, found that digoxin therapy had no effect on mortality but modestly reduced hospitalizations due to worsening heart failure. Digoxin is one of the oldest drugs in cardiovascular medicine, and it was traditionally used in patients with atrial fibrillation af and heart failure hf. With over one million hospitalizations each year, heart failure hf is the number one reason for hospital admission among population. Digoxin tablets, usp increase left ventricular ejection fraction and improve heart failure symptoms as evidenced by improved exercise capacity and decreased heart failure related hospitalizations and emergency care, while having no effect on mortality. Association guideline for the management of heart failure include digoxin as a.
A total of 18 studies were found that evaluated digoxin and overall mortality in different clinical settings including systolic congestive heart failure and normal sinus rhythm n 5, atrial fibrillation with and without systolic congestive heart failure n 9, and myocardial infarction n 4. Background the deleterious effects of discontinuation of digoxin on outcomes in ambulatory patients with chronic heart failure hf with reduced ejection fraction hfref receiving angiotensinconverting enzyme inhibitors are welldocumented. Unlike other interventions for heart failure, except cardiac resynchronisation. As per accfaha guidelines, a loading dose to initiate digoxin therapy in patients with heart failure is not necessary. Between january 2005 and june 2014, digoxin prescription. In contrast, the mean ratio of the fraction of digoxin dose absorbed to its apparent volume of distribution was increased by 37 per cent p in heart failure. This will often improve symptoms such as shortness of breath. Lanoxin digoxin dosing, indications, interactions, adverse. Atpase which results in a rise in the intracellular pool of free calcium. Jul 21, 2003 digoxin therapy has no effect on mortality in heart failure. The lifetime cost after diagnosis of heart failure can be attributed to the effectiveness in treatment of digoxin. Digoxin and reduction of heart failure hospitalization in. Overall, patients with systolic congestive heart failure with normal sinus rhythm, digoxin appears to have a neutral effect on mortality especially if close digoxin level monitoring is.
Digoxin therapy in acute heart failure springerlink. The use of digoxin in patients with worsening chronic heart. We used cluster analysis to delineate the clinical characteristics of hf patients in whom digoxin therapy was associated with improved or worsened clinical outcomes. The use of digoxin in patients with worsening chronic. Digoxin appears to be of most benefit in patients with severe heart failure, cardiomegaly and a third heart sound. Understanding the condition and optimizing treatment, youll learn the mechanics of the heart, the symptoms and warning signs of heart failure, and the keys to an effective treatment plan. The effectiveness of digoxin in treating heart failure. Digoxin should also be used with caution in patients with severe pulmonary disease, acute cor pulmonale, hypoxemia, hypothyroidism or myxedema, severe heart failure, amyloid cardiomyopathy, restrictive cardiomyopathy, or an otherwise damaged myocardium because the myocardium is more sensitive to the effects of digoxin, increasing the risk of. In addition, digoxin therapy improves signs and symptoms of hf and functional status 7,8. Complete the new medication information form pdf click to view external link. Heft to examine the relationship of baseline digoxin use and all. Although digoxin is one of the most commonly prescribed drugs for the treatment of heart failure, there is uncertainty about its longterm efficacy and safety.
Reanalyses of the trials findings have raised new questions about the. Identifying highrisk heart failure patients in a timely manner is critical to providing effective care. Multiple trials in different patient populations also show benefit of digoxin in heart failure patients, including women, elderly patients, renal disease patients, and patients with heart failure with preserved ejection fraction. While excess digoxin can have serious side effects eg, cardiac dysrhythmias, heart failure, seizures, death, it is one of the few therapeutic drugs for which antidotal therapy is available.
Digoxin for patients with atrial fibrillation and heart. The use of digitalis glycosides in the management of acute heart failure remains controversial 14. However, based on the results from clinical studies, the target digoxin blood level for effectively treating heart failure is between 0. Digoxin in the management of cardiovascular disorders circulation. Digoxin is often used to treat symptoms of heart failure. If you have heart failure, digoxin can improve your hearts ability to pump blood. Both the current canadian guidelines for heart failure and atrial fibrillation and. Digoxin is a cardioactive drug that is only 25% bound to serum proteins, mainly albumin. In other words, while digoxin may, to some extent, ameliorate the symptoms of heart failure it does not reverse or cure it nor does it reduce the risk of death from this condition1,2. Provided toxicity is avoided, digoxin is remarkably free of side effects. Digoxin pharmacokinetics in congestive heart failure.
Heart failure results when the heart cant pump blood well enough to supply the bodys needs. In 1997, the us food and drug administration approved digoxin for use in heart failure. Jul 15, 2000 although digoxin has been used to treat heart failure for more than 200 years, its role in patients with congestive heart failure and sinus rhythm is still debatable. Despite more than 200 years of clinical experience and a pivotal trial, digoxin, a purified cardiac glycoside derived from the foxglove plant, remains the most controversial drug in contemporary cardiovascular medicine.
The digitalis investigation group dig trial was a landmark randomized, doubleblind, placebo controlled multicenter trial on the effectiveness of digoxin in patients with congestive heart failure hf. During followup with a mean length of 37 months, 102 patients 21% in the digoxin group and 119 patients 24% in the placebo group hazard ratio hr, 0. Update on digoxin therapy in congestive heart failure. Objectives the goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with af and if the association was modified by heart failure andor serum digoxin concentration. Digoxin, also called digitalis, helps an injured or weakened heart pump more efficiently. Methods the association between digoxin use and mortality was assessed in 17,897. Digoxin should be used as a secondline drug after diuretics, angiotensin. Monitor digoxin levels periodically during treatment and make sure therapeutic levels are between 0. Nov 16, 2017 digoxin is a medicine used to treat certain heart problems such as heart failure.
Digoxin digoxin dose, indications, adverse effects. Digoxin tablets, usp increase left ventricular ejection fraction and improve heart failure symptoms as evidenced by improved exercise capacity and decreased heart failurerelated hospitalizations and emergency care, while having no effect on mortality. Effects of digoxin on left atrial function in heart failure. Prior the dig trial, digoxin was commonly prescribed for patients with heart failure with the intention of improving contractility and thus, cardiac output. A purified cardiac glycoside derived from the foxglove plant, digoxin increases ejection fraction, augments cardiac output, and reduces pulmonary capillary wedge pressure without causing deleterious increases in heart rate or decreases in blood.
Large intersubject variations in the serum digoxin concentration profiles were observed. Heart failure guidelines toolkit american heart association. Digoxin, a widely prescribed cardiac drug, has a narrow therapeutic window a very small difference exists between therapeutic and toxic tissue concentrations. The largest and most important of these was conducted by the digitalis investigation group dig,9 which involved 7788 patients with heart failure, all of whom were in sinus rhythm on entry into the trial. Digoxin discontinuation and outcomes in patients with. Digoxin toxicity is likely to occur if levels exceed 2 ng per ml. British researchers followed 484 heart failure patients for three years and found that the. Digoxin treatment in heart failure unveiling risk by. To assess the impact of digoxin therapy on outcomes in the current era of heart failure therapy, the authors analyzed data representing 5010 patients enrolled in the valsartan heart failure trial val. Pdf the effect of digoxin on mortality and morbidity in patients with. Digoxin therapy has long been used to treat heart failure. Getting good medical care, following doctors orders and learning about heart failure will help you lead a comfortable life. The association between serum digoxin concentration sdc and outcomes in women with heart failure hf has not been well studied. The cost rises as the aging population rises and the lifetime cost after diagnosis of heart failure increases 6.
Although digoxin has been used to treat heart failure for more than 200 years, its role in patients with congestive heart failure and sinus rhythm is still debatable. Complications dysrhythmias, cardiotoxicity, anorexia, nausea, vomiting, abdominal pain, increased fatigue, weakness, vision changes diplopia, blurred vision, yellowgreen or white halos around objects medication administration. Digoxin tablets, usp are indicated for the treatment of mild to moderate heart failure in adults. Digoxin therapy has no effect on mortality in heart failure. Contrary to the prevailing notion, we found that the oral administration of supplemental doses of digoxin only on the basis of its reduced serum concentration in patients with. The use of digoxin in the therapy of systolic heart failure and certain supraventricular tachycardias is. Digoxin is a medicine licensed to treat congestive heart failure and atrial fibrillation. Digoxin in heart failure with a reduced ejection fraction. Several retrospective studies have raised concerns regarding digoxin therapy in select subgroups of heart failure patients. Digoxin may be useful for maintaining clinical stability and exercise capacity in patients with symptomatic heart failure. If the ejection fraction is at least 50% the condition is called heart failure with preserved ejection fraction. Effects of digoxin on morbidity and mortality in diastolic. Pdf background the role of cardiac glycosides in treating patients with chronic heart failure and normal.