200-Year-Old Heart Drug Linked To Increased Risk Of Death Reply

For more than 200 years physicians have been trying to figure out how and when to use the heart drug digoxin.  Although it has a narrow therapeutic window and potentially dangerous interactions with other drugs, it is endorsed by current guidelines and widely given to patients with heart failure (HF) and atrial fibrillation (AF). However, there have been no randomized trials in AF and only one trial, the famous DIG trial, in HF. In that trial digoxin had no impact on mortality but was found to help reduce the rate of hospitalization for HF.

Now researchers led by Stefan Hohnloser have performed a meta-analysis, published in the European Heart Journal, of 19 studies of digoxin, including more than 235,000 AF patients and 91,000 HF patients.

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Digoxin is derived from the foxglove plant (Digitalis lanata). (Photo by Oli Scarff/Getty Images)

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Study Offers Little Support for an Old Drug Reply

Digoxin is one of the oldest drugs in the cardiovascular arsenal, derived from the foxglove plant and first described in the 18th century by William Withering. It is frequently used in patients with heart failure (HF) and with atrial fibrillation (AF). The few trials supporting its use were performed in HF patients before newer treatments arrived. There have been no good trials in AF.

A new observational study published in the Journal of the American College of Cardiology now provides the most detailed perspective on digoxin use in AF. …

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J Am Coll Cardiol. 2014; 64(7): 660-668.

 

 

Study Raises Questions About Digoxin Use Today Reply

Digitalis is one of the oldest medicines in the cardiovascular arsenal. When William Withering identified digitalis as the active ingredient in the foxglove plant more than 200 years ago he was only codifying a longstanding folk remedy for heart failure, or “dropsy” as it was known then.

Digitalis fully entered the modern era with the publication of the DIG trial in 1997. The trial found that digitalis reduced hospitalization for heart failure but did not have an impact on mortality. On the basis of the trial digitalis received recommendations in the US and European guidelines for use in patients with systolic heart failure who remain symptomatic despite optimal therapy. However, the epidemiology and treatment of heart failure have evolved considerably since then. Now the authors of a new study, supported by an accompanying editorial, say that these recommendations need to be reconsidered.

In a study published in Circulation: Cardiovascular Quality and Outcomes, James Freeman and colleagues followed 2,891 patients with newly diagnosed systolic heart failure, 18% of whom received digitalis. After 2.5 years the digoxin users had a higher rate of death and hospitalization for heart failure…

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