Digging into Dig[oxin]

Dr. Robert DiDomenico and CardioScripts co-host, Dr. Tracy Macaulay, discuss the RATE AF trial and all things digoxin: its past role, therapeutic levels, and current and future state!

0:00-0:32 Intro

0:28-1:02: Welcome back and Introduction of Dr. DiDomenico

1:03-4:33: Overview of the RATE-AF trial as presented at ESC 2020 and based on published trial rationale.

4:34-6:40: How did RATE AF confirm or add to our understanding of digoxin use in Atrial Fibrillation

6:41-9:36:  If we use digoxin, what levels are you targeting and what goals are you setting?

9:37-11:50: Digoxin in HFpEF patients

11:51-16:26: Digoxin and Mortality

16:27-17:28: Final thoughts

17:29-18:04: Closing

References:

  • Rate Control Therapy Evaluation in Permanent Atrial Fibrillation.  Results presented by Dr. Dipak Kotecha at the European Society of Cardiology Virtual Congress, August 29, 2020.
  • Kotecha D, Calvert M, Deeks JJ, et al.  A review of rate control in atrial fibrillation, and the rationale and protocol for RATE-AF trial.  BMJ Open 2017;7:e015099.
  • Ahmed A, Rich MW, Fleg JL et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation 2006;11397-403.
  • Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525–533. 11.
  • Ahmed A, Rich MW, Love TE, Lloyd-Jones DM, Aban IB, Colucci WS, Adams KF, Gheorghiade M. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J. 2006;27:178–186. 12.
  • Massie BM, Abdalla I. Heart failure in patients with preserved left ventricular systolic function: do digitalis glycosides have a role? Prog Cardiovasc Dis. 1998;40:357–369.
  • Adams KF Jr, Patterson JH, Gattis WA, et al. Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: a retrospective analysis.  J Am Coll Cardiol. 2005 Aug 2;46(3):497-504. 
  • Vamos M, Erath JW, Benz AP, et al. Meta-analysis of effects of digoxin on survival in patients with atrial fibrillation or heart failure: An update. Am J Cardiolo 2019;123:69-74.
  • DiDomenico RJ, Bress AP, NA-Thalang K, et al. Use of a simplified nomogram to individualize digoxin dosing versus standard dosing practice in patients with heart failure. Pharmacotherapy 2014; 34:1121-31.
  • Bauman JL, DiDomenico RJ, Viana M, Fitch M. A method of determining the dose of digoxin for heart failure in the modern era.  Arch Intern Med. 2006 Dec 11-25;166(22):2539-45. 
  • Singh S, Moore H, Karasik PE, et al. Digoxin initiation and outcomes in patients with heart failure (HFrEF and HFpEF) and atrial fibrillation. Am J Med 2002:S0002-9343(20)30528-3.

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