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digoxin management

Joanna Osmanska, Pardeep S Jhund
The foundation of the treatment of heart failure with reduced ejection fraction is a number of pharmacotherapies shown to reduce morbidity and mortality in large randomised multinational clinical trials. These include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and more recently, a combined angiotensin receptor blocker neprilysin inhibitor, sacubitril/valsartan. In select cases, digoxin, ivabradine and hydralazine with isosorbide dinitrate have a role to play in the treatment of heart failure with reduced ejection fraction...
December 11, 2018: Drugs & Aging
Ilektra Voulgareli, Alexandra Chronaiou, Dionisios Tsoukalas, George Tsoukalas
We report a case of endogenous lipoid pneumonia secondary to long-term use of amiodarone (> 30 years) for atrial fibrillation in a 76-year-old Caucasian woman, presenting with cough and dyspnea. Endogenous Lipoid pneumonia is a rare underdiagnosed condition more prevalent in adults. It is usually asymptomatic and a diagnosis is generally made in patients who have become clinically unstable or when an abnormal lung shadow is found on a chest X-ray. In the case here described it was diagnosed by fiberoptic bronchoscopy with bronchoalveolar lavage (BALF) where fat-laden macrophages (oil red O stain) were identified...
2018: Pneumonia
Martin Aguilar, Stanley Nattel
The vast majority of clinical arrhythmia-management research over the past couple of decades has focused on catheter-based therapeutic advances. There has been much less emphasis on rate-control strategies; however, the majority of patients with atrial fibrillation (AF) will require some form of rate-control management, making AF rate-control the single most widely used therapeutic component in AF-patients. While the general principles governing AF rate-control have remained largely unchanged, they are often underappreciated...
November 15, 2018: International Journal of Cardiology
Aaron B Kaye, Amar Bhakta, Alex D Moseley, Anupama K Rao, Sally Arif, Seth J Lichtenstein, Neelum T Aggarwal, Annabelle S Volgman, Rupa M Sanghani
Cardiovascular disease is now the leading cause of pregnancy-related deaths in the United States. Increasing maternal mortality in the United States underscores the importance of proper cardiovascular management. Significant physiological changes during pregnancy affect the heart's ability to respond to pathological processes such as hypertension and heart failure. These physiological changes further affect the pharmacokinetic and pharmacodynamic properties of cardiac medications. During pregnancy, these changes can significantly alter medication efficacy and metabolism...
November 8, 2018: Journal of Women's Health
Martin Aguilar, Stanley Nattel
Despite major advances in atrial fibrillation (AF) catheter ablation, rate control remains the most widely used management strategy for AF in the general population. In addition to its use as a primary approach to control symptoms and prevent complications of AF, rate control is often a necessary complement to rhythm-control strategies, especially with antiarrhythmic drugs. The value of rate-control therapy is supported by several large randomized clinical trials showing no difference in major cardiovascular outcomes between rate-control and rhythm-control strategies with currently available therapeutic approaches (antiarrhythmic drugs and/or catheter ablation)...
November 2018: Canadian Journal of Cardiology
Lucy M Bracken, Betty S H Chan, Nicholas A Buckley
CONTEXT: Recommended doses of digoxin-specific antibody fragments (digoxin-Fab) for treatment of acute digoxin poisoning are pharmacokinetically unsubstantiated and theoretically excessive. Physiologically based pharmacokinetic (PBPK) modelling creates clinical simulations which are closely related to physiological and pharmacokinetic behaviour. This paper details the formulation of a PBPK model of digoxin and explores its use as a simulation tool for acute digoxin toxicity and its management...
October 11, 2018: Clinical Toxicology
Elise J Smolders, Peter J G Ter Horst, Sharon Wolters, David M Burger
Direct-acting antivirals (DAAs) are known victims (substrate) and perpetrators (cause) of drug-drug interactions (DDIs). These DAAs are used for the treatment of hepatitis C virus (HCV) infections and are highly effective drugs. Drugs used for cardiovascular risk management are frequently used by HCV-infected patients, whom also are treated with DAAs. Therefore, the aim of this review was to describe DDIs between cardiovascular drugs (CVDs) and DAAs. An extensive literature search was performed containing search terms for the marketed DAAs and CVDs (β-blocking agents, ACE inhibitors, angiotensin II antagonists, renin inhibitors, diuretics, calcium channel blockers, statins/ezetimibe, fibrates, platelet aggregation inhibitors, vitamin K antagonists, heparins, direct Xa inhibitors, nitrates, amiodarone, and digoxin)...
September 27, 2018: Clinical Pharmacokinetics
Jeffrey B Washam, Manesh R Patel
PURPOSE OF REVIEW: A number of recent observational analyses have assessed clinical outcomes associated with digoxin use in patients with atrial fibrillation. In this review, we review these data and provide suggestions on the contemporary use of digoxin in patients with atrial fibrillation as supported by the recent evidence. RECENT FINDINGS: Observational data from clinical trials and registries have provided variable results on the safety and efficacy of chronic digoxin use in patients with atrial fibrillation...
September 12, 2018: Current Cardiology Reports
Mahmoud Hassanein, Magdy Abdelhamid, Bassem Ibrahim, Mohamed Sobhy, Gamela Nasr, Mohamed Wafaie Aboleineen, Ashraf Reda, Nabil Farag, Ahmed Elshazly, Tarek Khairy Abdeldayem, Fatma Elmesseiry, Hesham Boshra, Hesham Sobhy, Atef Elbahry, Amr Youssef, Medhat Ashmawy, Ahmed Abdelmoneim, Ayman Saleh, Yahya Elrakshy, Hamdy Ebeid
AIMS: This analysis evaluates gender differences in the Egyptian cohort of patients hospitalized for acute heart failure (AHF) in the European Society of Cardiology Heart Failure Long-Term Registry. METHODS AND RESULTS: From April 2011 to September 2014, 1634 patients hospitalized with AHF were enrolled by 20 hospitals all over Egypt. Of these patients, 1112 (68%) patients were male and 522 (32%) were female. Women presented with a higher admission systolic blood pressure and resting heart rate...
September 3, 2018: ESC Heart Failure
Sidra Khalid, Samin Yasar, Aariez Khalid, Timothy Pp Spiro, Abdo Haddad, Hamed Daw
Background Ibrutinib is a Bruton's tyrosine kinase inhibitor, which is United States Food and Drug Administration (FDA)-approved for chronic lymphocytic leukemia, mantle cell lymphoma, and Waldenström's macroglobulinemia. Ibrutinib is associated with atrial fibrillation and bleeding events. Our aim is to determine the management of prior atrial fibrillation when starting ibrutinib, as well as ibrutinib-induced atrial fibrillation. Our focus is on which rate and rhythm control strategies to use and decisions regarding the use of antiplatelet and anticoagulation agents...
May 29, 2018: Curēus
Niklas Bobrovitz, Carl Heneghan, Igho Onakpoya, Benjamin Fletcher, Dylan Collins, Alice Tompson, Joseph Lee, David Nunan, Rebecca Fisher, Brittney Scott, Jack O'Sullivan, Oliver Van Hecke, Brian D Nicholson, Sarah Stevens, Nia Roberts, Kamal R Mahtani
BACKGROUND: Rates of emergency hospitalisations are increasing in many countries, leading to disruption in the quality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a key priority. There have been large-scale evidence reviews to address this issue; however, there have been no reviews of medication therapies, which have the potential to reduce the use of emergency health-care services. The objectives of this study were to review systematically the evidence to identify medications that affect emergency hospital admissions and prioritise therapies for quality measurement and improvement...
July 26, 2018: BMC Medicine
Natali Jokanovic, Noha Ferrah, Janaka J Lovell, Carolina Weller, Lyndal Bugeja, J Simon Bell, Joseph E Ibrahim
BACKGROUND: Residential aged care is a complex and challenging clinical setting where medication errors continue to occur despite efforts to improve medication safety. No studies have sought to review and synthesize coronial investigations into medication-related deaths in Australian residential aged care facilities (RACFs). OBJECTIVE: To review coronial investigations into medication-related deaths in Australian RACFs. METHODS: A national review of medication-related deaths between July 2000 and July 2013 reported to Australian Coroners was performed...
June 12, 2018: Research in Social & Administrative Pharmacy: RSAP
Abrar-Ahmad Zulfiqar, Paul Blazejczyk, Nadir Kadri, Jean Doucet
Digitalis remains a treatment that is difficult to manage, especially in the elderly. METHODS: A retrospective, unicentric study carried out within the unit of Internal medicine and geriatrics, Reims University Hospital Center, between January and June 2014. Collection of all patients hospitalized, after 75 years, receiving treatment with digitalis, either as soon as they enter (present on the usual prescription of the patient), during their hospitalization and on their exit. RESULTS: 20 patients were included...
June 1, 2018: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
Yoshimori An, Masahiro Esato, Mitsuru Ishii, Moritake Iguchi, Nobutoyo Masunaga, Hikari Tsuji, Hiromichi Wada, Koji Hasegawa, Hisashi Ogawa, Mitsuru Abe, Gregory Y H Lip, Masaharu Akao
Management of atrial fibrillation (AF) with current rhythm-control therapy has an uncertain impact on outcomes. Among 3731 patients in the Fushimi AF Registry, a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, we investigated the characteristics and outcomes in 478 patients receiving rhythm-control therapy (anti-arrhythmic drug and/or catheter ablation) alone, with 1279 patients receiving rate-control therapy (beta-blockers, calcium channel blockers, and digoxin) alone serving as a reference...
May 24, 2018: Heart and Vessels
Ritesh G Menezes, Muhammad Shariq Usman, Syed Ather Hussain, Mohammed Madadin, Tariq Jamal Siddiqi, Huda Fatima, Pradhum Ram, Syed Bilal Pasha, S Senthilkumaran, Tooba Qadir Fatima, Sushil Allen Luis
Cerbera odollam is a plant species of the Apocynaceae family. It is often dubbed the 'suicide tree' due to its strong cardiotoxic effects, which make it a suitable means to attempt suicide. The plant grows in wet areas in South India, Madagascar, and Southeast Asia; and its common names include Pong-Pong and Othalanga. The poison rich part of the plant is the kernel which is present at the core of its fruit. The bioactive toxin in the plant is cerberin, which is a cardiac glycoside of the cardenolide class...
August 2018: Journal of Forensic and Legal Medicine
Handrean Soran, Moulinath Banerjee, Jamal B Mohamad, Safwaan Adam, Jan Hoong Ho, Shakawan M Ismaeel, Shaishav Dhage, Akheel A Syed, Ibrahem M A Abdulla, Naveed Younis, Rayaz A Malik
Introduction: Type 2 diabetes mellitus (T2DM) is a well-recognised risk factor for cardiovascular disease and the prevalence of atrial fibrillation (AF) is higher among patients with T2DM. Direct current cardioversion (DCCV) is an important management option in persistent AF. We sought to determine independent risk factors for immediate and short-term outcomes of DCCV for treatment of AF in patients with T2DM. Methods: Retrospective outcome analysis of DCCV for persistent AF in 102 T2DM patients compared with 102 controls...
2018: BioMed Research International
Richard Charnigo, Paul Khairy, Jing Guo, Azadeh Shohoudi, Claude S Elayi
BACKGROUND: Whether there is a causal association between digoxin and mortality among patients with atrial fibrillation (AF), with or without congestive heart failure (HF), has been controversial; in particular, two prior analyses of data from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial have yielded conflicting results. We sought to investigate how digoxin impacts mortality, in the full AFFIRM cohort and for various subgroups, by applying marginal structural modeling (MSM) to AFFIRM data...
April 16, 2018: Pacing and Clinical Electrophysiology: PACE
Marilyn A Prasun, Nancy M Albert
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is a progressive, chronic, and burdensome cardiovascular condition. It is associated with limiting symptoms, such as dyspnea and fatigue; a decline in functional capacity; and premature mortality and hospitalization. In heart failure (HF) management, heart rate is commonly assessed yet frequently overlooked as a modifiable risk factor and a predictor of mortality. An elevated heart rate increases myocardial demand and decreases diastolic filling time...
September 2018: Journal of Cardiovascular Nursing
Frederik Dalgaard, Martin H Ruwald, Tommi Bo Lindhardt, Gunnar H Gislason, Christian Torp-Pedersen, Jannik L Pallisgaard
BACKGROUND: The management of patients with non-valvular atrial fibrillation (NVAF) with rate-lowering or anti-arrhythmic drugs has markedly changed over the last decade, but it is unknown how these changes have affected patients with NVAF with a permanent pacemaker (PPM). METHODS: Through Danish nationwide registries, patients with NVAF and a PPM were identified from 2001 to 2012. Changes in concomitant pharmacotherapy and comorbidities were tested using the Cochran-Armitage trend test and linear regression...
2018: PloS One
Marise Gauci, Francesca Wirth, Liberato Camilleri, Lilian M Azzopardi, Anthony Serracino-Inglott
Background: Atrial fibrillation (AF) is highly prevalent in older persons and is associated with considerable morbidity and mortality. Assessing appropriateness of drug therapy in AF may be facilitated by application of medication assessment tools (MATs). Objective: To develop, psychometrically evaluate and apply an innovative MAT for the long-term management of AF with particular relevance to older persons. Methods: Key recommendations from clinical practice guidelines for the long-term management of AF were selected and review criteria defining appropriate drug therapy were constructed as a 'qualifying statement' followed by a 'standard'...
October 2017: Pharmacy Practice
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