Key result
Digoxin use is associated with an increased risk of death in patients with atrial fibrillation and heart failure, particularly at serum concentrations greater than 1.2 ng/mL, necessitating continuous therapeutic drug monitoring.
Why the study?
Due to the narrow therapeutic index of digoxin, appropriate treatment and continuous monitoring are required.
Does therapeutic drug monitoring of digoxin improve safety and efficacy in patients with heart failure and atrial fibrillation?
Does therapeutic drug monitoring of digoxin improve safety and efficacy in patients with heart failure and atrial fibrillation?
Digoxin remains a useful adjunct in HFrEF to reduce hospitalizations but requires strict therapeutic monitoring (0.5-0.7 ng/mL) and electrolyte surveillance due to its narrow therapeutic index.
Answers are grounded in this paper and cite their sources.
Supports low-dose digoxin consideration in HFrEF; leaves open confirmation by contemporary RCTs.
Digoxin was developed as a novel medication for the treatment of heart failure and atrial fibrillation (AF) 200 years ago. This investigation began with a PubMed and Google Scholar search for various papers using the terms digoxin safety and efficacy, digoxin in heart failure, and digoxin in atrial fibrillation. Digoxin should be administered at a dose of 0.5–0.7 ng/mL in individuals with heart failure and reduced ejection fraction. Digoxin should be administered to decrease hospital readmissions, although SDC, creatinine, and potassium levels should be continuously maintained to limit the risk of toxicity. Digoxin may be used in conjunction with diuretics, spironolactone, ACE inhibitors, or beta-blockers. It is preferable to take digoxin on a regular basis. Digoxin should not be used in the pre-excitation syndrome because it can result in the rapid development of accessory route conductors, which can finally result in ventricular fibrillation. Due to the narrow therapeutic index of digoxin, it requires appropriate treatment and continuous monitoring.
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Syahputra et al. (2022) conducted a review in Heart failure and atrial fibrillation. Digoxin vs. Placebo or standard care was evaluated on Mortality and toxicity. Digoxin use is associated with an increased risk of death in patients with atrial fibrillation and heart failure, particularly at serum concentrations greater than 1.2 ng/mL, necessitating continuous therapeutic drug monitoring.
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