scholarly journals Prognostic impact of digoxin use for rate control of atrial fibrillation in patients ≥75 years of age

2018 ◽  
Vol 88 (2) ◽  
Author(s):  
Maria Teresa La Rovere ◽  
Egidio Traversi
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Beta Blockers ◽  
Therapeutic Option ◽  
Adverse Outcomes ◽  
Prognostic Impact ◽  
Level Of Evidence ◽  
Narrow Therapeutic Range ◽  
Drug Concentrations ◽  
Current Guidelines

Digoxin use remains a common therapeutic option in the pharmacological control of heart rate in patients with atrial fibrillation, endorsed in current guidelines with the same level of evidence than beta-blockers in patients with and without heart failure. Digoxin has a narrow therapeutic range and is influenced by drug‐to‐drug interactions, serum electrolyte concentrations, and renal function. Conflicting data exist regarding adverse outcomes that are associated with digoxin use in patients with atrial fibrillation. It remains unclear whether the association between digoxin use and worse clinical outcome is causal or may be the result of confounding by differences in the characteristics of patents including age, comorbidities and treatment. Particularly in older patients with atrial fibrillation, who are frequently prescribed a multitude of agents for stroke prevention, treatment of cardiovascular disease and other comorbidities, use of digoxin should be cautious and instituted with assessment of drug concentrations.

scholarly journals Beta-blockers or Digoxin for Atrial Fibrillation and Heart Failure?

2016 ◽  
Vol 2 (1) ◽  
pp. 35 ◽  
Author(s):  
Laurent Fauchier ◽  
Guillaume Laborie ◽  
Nicolas Clementy ◽  
Dominique Babuty ◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Beta Blocker ◽  
Rate Control ◽  
Beta Blockers ◽  
Therapeutic Option ◽  
Systolic Dysfunction ◽  
Ventricular Rate ◽  
Channel Blockers ◽  
Reduced Ejection Fraction

In patients with atrial fibrillation (AF) and heart failure (HF) with or without systolic dysfunction, either rhythm control or rate control is an acceptable primary therapeutic option. If a rate control strategy is chosen, treatment with a beta-blocker is almost always required to achieve rate control. Adequate ventricular rate control is usually a resting rate of less than 100 beats per minute, but lower resting rates may be appropriate. Non-dihydropyridine calcium channel blockers are often contraindicated when AF is associated with HF with systolic dysfunction. There have been recent debates on a possible reduced efficacy of beta-blockers as well as safety issues with digoxin when treating HF patients with AF. The benefit of beta-blockers on survival may be lower in patients with HF with reduced ejection fraction when AF is present. Digoxin does not improve survival but may help to obtain satisfactory rate control in combination with a beta-blocker. Digoxin may be useful in the presence of hypotension or an absolute contraindication to beta-blocker treatment.

scholarly journals Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

2021 ◽  
Vol 18 (5) ◽  
pp. 2237
Author(s):  
Youn-Jung Son ◽  
Da-Young Kim ◽  
Mi Hwa Won
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Older Adults ◽  
Sex Differences ◽  
Older Adult ◽  
Hospital Readmission ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Prognostic Impact ◽  
Male And Female

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

Abstract P369: Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Elderly Patients With Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Aniqa Alam ◽  
Nemin Chen ◽  
Pamela L Lutsey ◽  
Richard MacLehose ◽  
J'Neka Claxton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Rate Control ◽  
Treatment Effectiveness ◽  
Adverse Outcomes ◽  
Pharmacy Claims ◽  
Increased Risk ◽  
The Impact

Background: Polypharmacy is highly prevalent in elderly individuals with chronic conditions, including atrial fibrillation (AF). The impact of polypharmacy on adverse outcomes and on treatment effectiveness in elderly AF patients remains unaddressed. Methods: We studied 338,810 AF patients ≥75 years of age with 1,761,660 active prescriptions [mean (SD), 5.1 (3.8) per patient] enrolled in the MarketScan Medicare Supplemental database in 2007-2015. Polypharmacy was defined as ≥5 active prescriptions at AF diagnosis based on outpatient pharmacy claims. AF treatments (oral anticoagulation, rhythm and rate control) and cardiovascular endpoints (ischemic stroke, bleeding, heart failure) were defined based on inpatient, outpatient and pharmacy claims. Multivariable Cox models were used to estimate associations of polypharmacy with cardiovascular endpoints and the interaction between polypharmacy and AF treatments in relation to cardiovascular endpoints. Results: Prevalence of polypharmacy was 52% (176,007 of 338,810). Patients with polypharmacy had increased risk of major bleeding [hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.12, 1.20] and heart failure (HR 1.33, 95%CI 1.29, 1.36), but not of ischemic stroke (HR 0.96, 95%CI 0.92, 1.00), compared to those not with polypharmacy (Table). Polypharmacy status did not consistently modify the effectiveness of oral anticoagulants. However, rhythm control (vs. rate control) was more effective in preventing heart failure hospitalization in patients not with polypharmacy (HR 0.87, 95%CI 0.76, 0.99) than among those with polypharmacy (HR 0.98, 95%CI 0.91, 1.07, p for interaction = 0.02). Conclusion: Polypharmacy is frequent among elderly patients with AF, associated with adverse outcomes, and potentially affecting the effectiveness of AF treatments. Optimizing management of polypharmacy in elderly AF patients may lead to improved outcomes.

scholarly journals Heart rate control using beta-blockers for heart failure with atrial fibrillation: more than enough is too much

2019 ◽  
Vol 42 (11) ◽  
pp. 1826-1827
Author(s):  
Takahiro Okumura ◽  
Yuki Kimura ◽  
Toyoaki Murohara
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Rate Control ◽  
Beta Blockers ◽  
Heart Rate Control

Management of acute presentation with atrial fibrillation - rate control

ESC CardioMed ◽  
2018 ◽  
pp. 2142-2144
Author(s):  
Christian Sticherling ◽  
Michael Kuehne
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Beta Blockers ◽  
Negative Inotropic Effect ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
First Choice ◽  
Intravenous Amiodarone ◽  
Onset Atrial Fibrillation

Many patients with new-onset atrial fibrillation require acute rate control. Beta blockers and non-dihydropyridine calcium channel antagonists (verapamil/diltiazem) are the first choice and can be given intravenously. Digoxin can be added if a resting heart rate of less than 110 bpm cannot be achieved. In patients with signs of heart failure or a known left ventricular ejection fraction less than 40%, small doses of beta blocker should be given and digoxin may be added. Because of their pronounced negative inotropic effect, verapamil and diltiazem should not be used in these circumstances. In unstable patients, intravenous amiodarone can be used for acute rate control. Haemodynamically unstable patients should be considered for urgent cardioversion. After achieving rate control the need for anticoagulation should be assessed and an echocardiogram needs to be performed before deciding on further management.

scholarly journals Safety and Efficiency of Calcium Channel Blockers Versus Beta-blockers for Rate Control in Patients With Atrial Fibrillation and No Acute Underlying Medical Illness

2013 ◽  
Vol 20 (3) ◽  
pp. 222-230 ◽  
Author(s):  
Frank Xavier Scheuermeyer ◽  
Eric Grafstein ◽  
Rob Stenstrom ◽  
Jim Christenson ◽  
Claire Heslop ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Rate Control ◽  
Beta Blockers ◽  
Medical Illness ◽  
Channel Blockers

scholarly journals Trends in the pharmacological management of atrial fibrillation in UK general practice 2008–2018

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319338
Author(s):  
Katherine Phillips ◽  
Anuradhaa Subramanian ◽  
G Neil Thomas ◽  
Nazish Khan ◽  
Joht Singh Chandan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Rate Control ◽  
Beta Blockers ◽  
Rhythm Control ◽  
Cross Sectional ◽  
Pharmacological Management ◽  
Stroke Outcomes ◽  
European Society Of Cardiology ◽  
The Uk

ObjectiveThe pharmacological management of atrial fibrillation (AF) comprises anticoagulation, for stroke prophylaxis, and rate or rhythm control drugs to alleviate symptoms and prevent heart failure. The aim of this study was to investigate trends in the proportion of patients with AF prescribed pharmacological therapies in the UK between 2008 and 2018.MethodsEleven sequential cross-sectional analyses were performed yearly from 2008 to 2018. Data were derived from an anonymised UK primary care database. Outcomes were the proportion of patients with AF prescribed anticoagulants, rhythm and rate control drugs in the whole cohort, those at high risk of stroke and those with coexisting heart failure.ResultsBetween 2008 and 2018, the proportion of patients prescribed anticoagulants increased from 45.3% (95% CI 45.0% to 45.7%) to 71.1% (95% CI 70.7% to 71.5%) driven by increased prescription of non-vitamin K antagonist anticoagulants. The proportion of patients prescribed rate control drugs remained constant between 2008 and 2018 (69.3% (95% CI 68.9% to 69.6%) to 71.6% (95% CI 71.2% to 71.9%)). The proportion of patients prescribed rhythm control therapy by general practitioners (GPs) decreased from 9.5% (95% CI 9.3% to 9.7%) to 5.4% (95% CI 5.2% to 5.6%).ConclusionsThere has been an increase in the proportion of patients with AF appropriately prescribed anticoagulants following National Institute for Health and Care Excellence and European Society of Cardiology guidelines, which correlates with improvements in mortality and stroke outcomes. Beta-blockers appear increasingly favoured over digoxin for rate control. There has been a steady decline in GP prescribing rates for rhythm control drugs, possibly related to concerns over efficacy and safety and increased availability of AF ablation.

Rate control: medical therapy

ESC CardioMed ◽  
2018 ◽  
pp. 2155-2159
Author(s):  
Isabelle C. Van Gelder ◽  
Michiel Rienstra ◽  
Laurent Pison ◽  
Harry J. G. M. Crijns
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Rate Control ◽  
Beta Blockers ◽  
Systolic Heart Failure ◽  
Atrioventricular Node ◽  
Channel Blockers ◽  
Control Approach ◽  
Important Message ◽  
Reasonable Choice

Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. The choice of rate control depends on symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate control is part of the management. Choice of drugs is patient dependent and driven by the patient-specific rate–symptom relationship as well as associated conditions. Beta blockers, alone or in combination with digoxin, or non-dihydropyridine calcium channel blockers effectively lower the heart rate. Digoxin is least effective, but a reasonable choice for older, physically inactive patients, in whom other therapies are ineffective or contraindicated, and as an additional drug, especially in systolic heart failure. Institution of all rate control drugs should be performed cautiously. Atrioventricular node ablation with pacemaker insertion for rate control should be the approach of last resort. Catheter ablation of atrial fibrillation, however, should be considered before atrioventricular node ablation. No one formula can integrate the best approach to a specific drug or the effects of therapeutic combinations, but one important message is that a lenient approach to rate control is easy, safe, and effective in many patients and should be considered as the initial approach. A stricter rate control approach is adopted when symptoms persist or deterioration of the left ventricular function occurs. Although rate control is the top priority and one of the first management issues for all patients with atrial fibrillation, and has been studied extensively, many issues remain.

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