Is it safe to prescribe digoxin after acute myocardial infarction? Update on continued controversy

Leor, Jonathan; Goldbourt, Uri; Behar, Solomon

doi:10.1016/0002-8703(95)90186-8

Cited by 9 publications

(3 citation statements)

References 43 publications

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“…Earlier studies on the impact of AF on death following an AMI produced discrepant results, with some studies showing no adverse effect on mortality and others suggesting an increased risk for death [9,22,23,24,25,26]. This study demonstrated that AF was independently associated with mortality in the presence of CKD, but this association was not significant in non-CKD patients.…”

Section: Discussioncontrasting

confidence: 57%

Clinical Significance of Chronic Kidney Disease and Atrial Fibrillation on Morbidity and Mortality in Patients with Acute Myocardial Infarction

Hwang¹,

Park

Yoon³

et al. 2014

Am J Nephrol

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Background/Aims: Atrial fibrillation (AF) often coexists with acute myocardial infarction (AMI), and chronic kidney disease (CKD) is a major risk for AMI. However, the combined impact of CKD and AF on the mortality and morbidity in AMI population has not been determined. Methods: Between January 2004 and December 2009, a total of 4,738 AMI patients were enrolled prospectively. Patients were divided into four groups according to the combined status of CKD and AF. The primary endpoint was a combination of 5-year major adverse cardiac and cerebrovascular events (MACCE). Results: The prevalence of AF was significantly higher in CKD patients than in non-CKD patients (6.76 vs. 3.31%, p < 0.001). The highest cumulative event rate of MACCE and death was observed in patients with both CKD and AF (68.5 and 64.0%), respectively. In multivariable analyses, compared with patients with neither AF nor CKD, hazard ratios (HR) for composite of MACCE were 1.66 (95% CI, 1.14-2.41), 1.24 (95% CI, 1.06-1.46), and 2.10 (95% CI, 1.42-3.13) for patients with AF only, those with CKD only, and those with both CKD and AF, respectively (p for interaction = 0.935). Patients with both CKD and AF had a greatest risk for all-cause mortality (HR 2.54; 95% CI, 1.60-4.53), and the significant synergistic interaction was observed between CKD and AF (p for interaction = 0.015). Conclusion: The combined effect of AF and CKD on the risk of MACCE after an AMI is stronger than any separate condition, and it confers a synergistic effect on the all-cause mortality risk.

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Section: Discussioncontrasting

confidence: 57%

Clinical Significance of Chronic Kidney Disease and Atrial Fibrillation on Morbidity and Mortality in Patients with Acute Myocardial Infarction

Hwang¹,

Park

Yoon³

et al. 2014

Am J Nephrol

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“…[43][44][45][46] Similarly, controversy remains on the use of digoxin with some studies showing an increase in mortality to be associated with the use of digoxin in certain patients. [47][48][49][50][51][52] However, despite this mortality risk, a significant proportion of patients in this study were still prescribed digoxin. This is consistent with a randomized HF study in which approximately 30% of patients with New York Heart Association class II/III were receiving digoxin.…”

Section: Adherence To Acute Heart Failure Therapiesmentioning

confidence: 95%

Evaluating the Adherence to Guidelines for Management of Acute Heart Failure in the Gaza Strip Hospitals: A Medical Chart–Based Review Study

Elshami

Dabbour

Alkhatib

et al. 2019

Global Journal on Quality and Safety in Healthcare

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Objective: To evaluate adherence of clinicians to the European guidelines for management of acute heart failure (AHF). Materials and Methods: This was a medical chart-based review study conducted from January to December 2016, including 200 medical records of patients admitted to two major hospitals in the Gaza Strip, Palestine. The AHF management was compared to the European Society of Cardiology (ESC) Guidelines, 2016. Results: The patients' mean age was 66.0 ± 13.0 years. A total of 100 patients (50.0%) were women and 192 (96.0%) had comorbidities including hypertension, diabetes, and heart disease. The most notable finding was that of a very poor standard of documentation, especially for vital signs. Patient management showed mostly moderate to good adherence to guidelines with 189 (94.5%) patients undergoing electrocardiogram, 90 (45.0%) echocardiography, 97 (48.5%) chest X-ray, and 79 patients of 167 (47.3%) receiving vasodilators appropriately. Good adherence was found in checking glucose levels, 176 (88.0%), and application of oxygen (100% with SpO 2 < 90%). Some aspects of care showed poor adherence, such as overuse of digoxin in 57 patients (28.5%), of which only 30 (53.4%) had atrial fibrillation and inappropriate use of beta-blockers in two patients who were hypotensive. Furthermore, brain natriuretic peptide was not used at all. Conclusion: The results of this study show suboptimal adherence to the ESC guidelines in management of AHF, reflecting the need to improve awareness of evidence-based medicine among clinicians.

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“…1 Adverse effects are also reported in patients with acute myocardial infarction. 13 Digoxin is commonly used with an interruption of two days a week. [14][15][16][17] Since the only available oral form of the medication in our country is 0.25mg tablets, many physicians prefer to prescribe 0.25mg/ day, except one or two days per week (0.25mg/day-5/7 regimen) to avoid inadvertent toxic effects.…”

Section: Introductionmentioning

confidence: 99%

Comparison of heart rate and symptoms in two different methods of digoxin prescription

Mousavi¹,

Akbarian²

2021

JCCR

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Background: Medication interruption of two days a week is common in Iran to avoid the toxic effects of digoxin; however, the efficacy on symptoms and heart rate is not well studied yet. Methods:The current clinical trial was conducted on patients receiving a digoxin regimen of 0.125mg/day or 0.25 mg/day except for Mondays and Fridays (0.25mg/day-5/7) for atrial fibrillation (AF) or heart failure (HF). After measuring digoxin level and heart rate and scoring the clinical symptoms, the enrolled patients were switched to another method of digoxin prescription. The symptoms were reevaluated after four weeks of changing the regimen of digoxin. The study was registered in the Iranian Registry of Clinical Trials (IRCT) (No. 20110512006463N2).Results: A total of 77 patients completed the study. The mean age of the enrolled group was 65.16±11.64 years, and 44 patients (55.7%) were female. The mean digoxin level was 0.76±0.35 in the 0.125mg/day regimen, which changed to 0.94±0.56 in the 0.25mg/day-5/7 regimen (P=0.034). Heart rate (HR) and daily activity scores, pain, spiritual feelings, energy, dyspnea, palpitation, nausea, blurred vision, and quality of life did not show any significant changes in the two regimens. The results of subgroup analysis in patients with AF were similar in terms of HR and symptoms, while in the subjects without AF, the scores of daily activity, dyspnea, palpitation, and quality of life significantly improved with the 0.25mg/day-5/7 regimen. Conclusions:Results of the current study showed that the HR and symptoms were not considerably different in the two regimens, whereas the digoxin level was significantly higher in the 0.25mg/day-5/7 regimen. Furthermore, in the subgroup with HF but without AF, the 0.25mg/day-5/7 regimen offered a better symptom control of dyspnea, palpitation, daily activity, and quality of life.

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Is it safe to prescribe digoxin after acute myocardial infarction? Update on continued controversy

Cited by 9 publications

References 43 publications

Clinical Significance of Chronic Kidney Disease and Atrial Fibrillation on Morbidity and Mortality in Patients with Acute Myocardial Infarction

Clinical Significance of Chronic Kidney Disease and Atrial Fibrillation on Morbidity and Mortality in Patients with Acute Myocardial Infarction

Evaluating the Adherence to Guidelines for Management of Acute Heart Failure in the Gaza Strip Hospitals: A Medical Chart–Based Review Study

Comparison of heart rate and symptoms in two different methods of digoxin prescription

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