In ‘An Account of the Foxglove and Some of its Medical Uses,' published in 1785, Sir William Withering cautioned readers that extracts from the plant foxglove, also called digitalis, was not a perfect drug. ‘Time will fix the real value upon this discovery,' he wrote. Now, more than 200 years later, researchers have validated Withering's warning with the discovery that patients with atrial fibrillation who are treated with the digitalis-derivative digoxin are more likely to die than similar patients who received different treatments.
Digoxin tied to increased risk of death in patients with atrial fibrillation…Mintu Turakhia, MD, is the study's lead author and assistant professor of cardiology at Stanford and director of cardiac electrophysiology at the Veterans Affairs Palo Alto Health Care System.
The take-home point is to question whether people should really be on this drug. These data challenge the current guidelines.
Turakhia and his team analyzed records from 122,465 patients (predominantly male) who received a new diagnosis of atrial fibrillation from the U.S. Department of Veterans Affairs health-care system between 2003 and 2008.
Doctors prescribed digoxin to 23 percent of the patients, and 70 percent of those patients were still on the drug one year later. Patients treated with digoxin were 1.2 times more likely to die than comparable patients prescribed other therapies.
Patients receiving digoxin were more likely to die regardless of age; use of other drugs such as beta-blockers, amiodarone or warfarin; or the presence of other factors such as kidney disease, heart attack or heart failure.
This is going to be as close to proof positive as we get because we may never have a randomized trial of this drug.
There's an evidence gap…
Turakhia said many other drugs with better safety results are available to treat atrial fibrillation. Digoxin slows the heart rate but does not correct it to a normal rhythm. “We are not asserting this drug should never be used,” he said. “However, in light of the many other drugs that can be used to slow down the heart rate in atrial fibrillation, patients and providers need to ask whether digoxin should be the treatment of choice when there are other, safer drugs. ”
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