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Study highlights increased risk of death among patients with atrial fibrillation who take digoxin

After a decade of focusing on treatments for heart failure and heart attacks, it’s atrial fibrillation’s turn in the spotlight, said Mintu Turakhia, MD, MAS,  assistant professor of cardiology and director of cardiac electrophysiology for Palo Alto VA Health Care System.

“It’s a huge cost to society and one of the most common inpatient diagnoses,” Turakhia said.

Atrial fibrillation is an irregular and rapid heart rate — caused by spasms of the heart’s upper chambers — that afflicts more than 3 million Americans, increasing their risk of stroke and heart failure. Turakhia and his team planned to dig beneath the surface of atrial fibrillation using data from more than 122,000 patients with recent atrial fibrillation diagnoses in the U.S. Department of Veterans Affairs (VA) health-care system.

They started by examining the efficacy of digoxin, a generic drug derived from the plant foxglove. The results were striking: Patients who received digoxin were 3 percent more likely to die than similar patients.

“The take-home point is to question whether people should really be on this drug,” Turakhia said in a release. “These data challenge the current guidelines.”

Both doctors and patients assumed digoxin was safe because derivatives of foxglove had been used for centuries, not because it had been proven safe or effective, Turakhia said. He said there are many other preferable treatments for atrial fibrillation and he plans to work to standardize treatment for atrial fibrillation in coming years.

“Can we be smarter about how we deliver atrial fibrillation care so it’s delivered efficiently with less variation?” Turakhia asked.

The study will be published in the Aug. 19 issue of the Journal of the American College of Cardiology, which appears online today.

Becky Bach is a former park ranger who now spends her time writing, exploring, or practicing yoga. She’s currently a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Hybrid procedure helps treat difficult cases of atrial fibrillation and Newly approved drug appears to provide more cost-effective stroke prevention than warfarin

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