Expert Consensus on the Diagnosis and Management of Digoxin Toxicity
Jason B Hack1, Sue Wingate2, Ron Zolty3
1Brody School of Medicine, East Carolina University, Greenville, Nc.
The American Journal of Medicine
|September 12, 2024
Summary
Despite decreased digoxin use, digoxin toxicity is a persistent clinical issue. Formalized guidance on diagnosis and treatment, including digoxin immune Fab for severe cases, is now available to aid clinicians.
Area of Science:
- Cardiology
- Medical Toxicology
- Clinical Pharmacology
Background:
- Digoxin toxicity presents diagnostic and therapeutic challenges due to its narrow therapeutic window and nonspecific symptoms.
- Despite a decline in digoxin use for heart failure and atrial fibrillation, toxicity remains a significant clinical problem.
Purpose of the Study:
- To develop consensus-based diagnostic and therapeutic guidelines for acute and chronic digoxin toxicity.
- To address clinical uncertainty surrounding digoxin toxicity management.
Main Methods:
- A systematic review of 34,587 publications on digoxin toxicity was conducted, with 114 meeting inclusion criteria.
- 33 consensus statements were developed and evaluated by a modified Delphi process involving expert clinicians.
Main Results:
- Agreement was reached on considering the time and nature of digoxin exposure (acute, chronic).
- Digoxin immune Fab was recommended for life-threatening exposures to reduce mortality risk.
- Several areas requiring further research and clinical attention were identified.
Conclusions:
- Formalized guidance is provided to assist healthcare providers in managing digoxin toxicity.
- This work aims to improve the clinical approach to a persistent challenge in patient care.
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