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Related Concept Videos

Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution01:00

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...
Therapeutic Drug Monitoring: Drug Analysis Methods01:26

Therapeutic Drug Monitoring: Drug Analysis Methods

Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood or body tissues to tailor drug therapy effectively. This monitoring is critical for managing drugs with narrow therapeutic indices like digoxin and phenytoin, ensuring they are both safe and effective. For instance, monitoring theophylline levels in asthma patients involves precision and sensitivity to adjust doses according to individual responses to therapy, ensuring efficacy and...
Drug Toxicity: Risk factors01:24

Drug Toxicity: Risk factors

Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...
Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...

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Related Experiment Videos

Increased mortality among patients taking digoxin--analysis from the AFFIRM study.

Matthew G Whitbeck1, Richard J Charnigo, Paul Khairy

  • 1Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 900 South Limestone Street, Lexington, KY 40536-0200, USA.

European Heart Journal
|November 29, 2012
PubMed
Summary

Digoxin use in atrial fibrillation (AF) patients is linked to higher mortality rates, even after accounting for other health issues. This study questions the drug's broad application in AF management.

Keywords:
ArrhythmiasAtrial fibrillationCongestive heart failureDigoxinMortality

Related Experiment Videos

Area of Science:

  • Cardiology
  • Clinical Pharmacology

Background:

  • Digoxin is commonly prescribed for rate control in atrial fibrillation (AF).
  • Previous observations suggest a potential association between digoxin use and increased mortality in AF patients.
  • It remains uncertain if this mortality risk is due to digoxin's toxic effects or if it reflects prescribing to patients with more severe comorbidities.

Purpose of the Study:

  • To investigate the relationship between digoxin administration and mortality risk in patients diagnosed with atrial fibrillation (AF).
  • To determine if digoxin is independently associated with increased mortality, irrespective of patient comorbidities.

Main Methods:

  • Analysis of data from the AF Follow-Up Investigation of Rhythm Management (AFFIRM) trial.
  • Multivariate Cox proportional hazards models were employed to assess mortality risk.
  • Subgroup analyses were performed based on the presence or absence of heart failure (HF).

Main Results:

  • Digoxin use was significantly associated with increased all-cause mortality (HR 1.41, P < 0.001).
  • Elevated risks were also observed for cardiovascular mortality (HR 1.35, P = 0.016) and arrhythmic mortality (HR 1.61, P = 0.009).
  • This association persisted in patients with and without heart failure, and no significant gender interaction was found.

Conclusions:

  • Digoxin is independently associated with a significant increase in all-cause mortality among atrial fibrillation patients.
  • The increased mortality risk linked to digoxin was consistent across different patient subgroups, including those with and without heart failure.
  • These findings challenge the established practice of widespread digoxin use for rate control in AF.