digoxin and Coronary-Artery-Disease

Heart failure affects more than 6 million people in the United States and incurs a heavy toll in morbidity, mortality, and health care costs. It frequently coexists with other important disorders, including hypertension, coronary artery disease, diabetes, and obesity. Decades of clinical trials have shown that several medications and interventions are effective for improving outcomes; however, mortality and hospitalization rates remain high. More recently, additional medications and devices have shown promise in reducing the health burden of heart failure.

Topics: Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cardiac Rehabilitation; Cardiovascular Agents; Coronary Artery Disease; Defibrillators, Implantable; Diabetes Complications; Diagnostic Techniques, Cardiovascular; Digoxin; Diuretics; Heart Failure; Hospitalization; Humans; Hydralazine; Hypertension; Isosorbide Dinitrate; Ivabradine; Life Style; Mineralocorticoid Receptor Antagonists; Palliative Care; Primary Prevention; Referral and Consultation; Risk Factors

The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.

Topics: Acute Coronary Syndrome; Algorithms; Anticoagulants; Atrial Appendage; Atrial Fibrillation; Cardiac Pacing, Artificial; Cardiotonic Agents; Catheter Ablation; Coronary Artery Disease; Digoxin; Drug Therapy, Combination; Factor Xa Inhibitors; Fibrinolytic Agents; Hemorrhage; Humans; Magnesium; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Postoperative Complications; ST Elevation Myocardial Infarction; Stroke

Heart failure remains a major health problem in the United States, affecting 5.8 million Americans. Its prevalence continues to rise due to the improved survival of patients. Despite advances in treatment, morbidity and mortality remain very high, with a median survival of about 5 years after the first clinical symptoms. This article describes the causes, classification, and management goals of heart failure in Stages A and B.

Topics: Adrenergic beta-Antagonists; Alcohol Drinking; Angiotensin-Converting Enzyme Inhibitors; Cardiac Pacing, Artificial; Cardiotonic Agents; Cardiotoxins; Coronary Artery Disease; Defibrillators, Implantable; Diabetic Cardiomyopathies; Digoxin; Dyslipidemias; Early Diagnosis; Endocrine System Diseases; Heart Failure; HIV Infections; Humans; Hypertension; Metabolic Syndrome; Mineralocorticoid Receptor Antagonists; Renal Insufficiency, Chronic; Risk Factors; Sedentary Behavior; Sleep Apnea Syndromes; Smoking; Tachycardia

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Cardiac Catheterization; Contraindications; Coronary Artery Bypass; Coronary Artery Disease; Digoxin; Diuretics; Electrocardiography; Female; Humans; Intra-Aortic Balloon Pumping; Patient Care Team; Pregnancy; Pregnancy Complications, Cardiovascular

Digoxin provides symptomatic relief in patients with systolic heart failure, yet it has potential proarrhythmic mechanisms and has not been formally studied in patients with cardiac resynchronization therapy-defibrillators (CRT-Ds). We evaluated the association between digoxin use and appropriate tachyarrhythmia therapy in patients with CRT-D with advanced heart failure, analyzing the incidence of appropriate device therapies and overall survival in 350 consecutive primary prevention recipients with CRT-D with baseline left ventricular ejection fraction (LVEF) ≤35%, non-right bundle-branch block native QRS complex ≥120 ms, New York Heart Association III to IV heart failure, and significant coronary artery disease. Digoxin was prescribed in 162 patients (46%) at discharge from CRT-D implant. Over 48 ± 32 months of follow-up, 59 patients (17%) received ≥1 appropriate shock. Digoxin therapy was associated with shorter time to first shock in intention-to-treat (corrected hazard ratio 2.18, 95% confidence interval 1.23 to 3.87, p = 0.007) and on-treatment analysis (corrected hazard ratio 2.27, 95% confidence interval 1.27 to 4.07, p = 0.006). Patients prescribed digoxin had a lower baseline LVEF, and digoxin therapy was associated with increased risk of shocks only in patients with LVEF <22% (median); there was no increased risk in patients with LVEF ≥22%. Overall survival and incidence of antitachycardia pacing were similar regardless of digoxin therapy. In conclusion, digoxin therapy is associated with increased likelihood of appropriate CRT-D shocks for rapid ventricular arrhythmias in primary prevention patients with coronary artery disease, and this risk appears to be most evident in patients with more severe baseline LV dysfunction. Digoxin use should be reexamined prospectively in patients with CRT-D.

Topics: Aged; Arrhythmias, Cardiac; Cardiac Resynchronization Therapy; Cardiotonic Agents; Coronary Artery Disease; Death, Sudden, Cardiac; Defibrillators, Implantable; Digoxin; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Male; Primary Prevention; Prospective Studies; Stroke Volume; Treatment Outcome; Ventricular Function, Left

The management of the coexistence of heart disease and kidney disease is increasingly challenging for clinicians. Chronic kidney disease (CKD) is not only a prevalent comorbidity of patients with heart failure but has also been identified as a noteworthy risk factor for all-cause mortality and poor clinical outcomes. Digoxin is one of the commonest treatments for heart disease. There are few trials investigating the role of digoxin in patients with cardiorenal syndrome (CRS). This study aims to examine the association between digoxin usage and clinical outcomes in patients with CRS in a nationwide cohort.. We conducted a population-based study that included 705 digoxin users with CRS; each patient was age, sex, comorbidities, and medications matched with three non-users who were randomly selected from the CRS population. Cox proportional hazards regression analysis was conducted to estimate the effects of digoxin on the incidence of all-cause mortality, congestive heart failure (CHF) hospitalization, coronary artery disease (CAD) hospitalization, and end-stage renal disease (ESRD).. The all-cause mortality rate was significantly higher in digoxin users than in non-users (adjusted hazard ratio [aHR] = 1.26; 95% confidence interval [CI] = 1.09-1.46,. Digoxin should be prescribed with caution to patients with CRS.

Topics: Cardio-Renal Syndrome; Coronary Artery Disease; Digoxin; Heart Failure; Hospitalization; Humans; Kidney Failure, Chronic

Topics: Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Coronary Artery Disease; Digoxin; Heart Failure; Humans; Middle Aged; Prospective Studies; Risk Factors

This analysis was designed to investigate the relationship between drug application and mortality rate in Chinese older coronary artery disease (CAD)/chronic heart failure (CHF) patients with and without low glomerular filtration rate (GFR).. All 1050 Chinese hospitalized patients with diagnosed CAD were included in this analysis, and Cox Regression was used to analyze the relationship between drug application and mortality rate after multivariate adjustment. Low GFR was defined as GFR < 60 ml/min/1.73m. There were 372 patients (35.4%) with low GFR in patients with CAD (1050 patients), and 168 patients (51.4%) in patients with CHF (327 patients). In CAD patients without low GFR, clopidogrel [P = 0.028, odds ratio (OR): 0.620, 95% confidence interval (CI): 0.404-0.951] rather than aspirin (P = 0.173) was significantly associated with lower mortality rate. Statins (P < 0.001, OR: 0.287, 95% CI: 0.180-0.456) were significantly associated with lower mortality rate. In CAD patients with low GFR, aspirin, clopidogrel and statins had no significant relationship with mortality rate (P > 0.05 for all). In CHF patients without low GFR, statins were significantly associated with lower mortality rate (P < 0.001, OR: 0.220, 95% CI: 0.098-0.490). In CHF patients with low GFR, statins had no significant relationship with mortality rate (P > 0.05 for all).. Clopidogrel but not aspirin was beneficial in Chinese older CAD patients without low GFR rather than those with low GFR, and statins benefited for Chinese older CAD/CHF patients without low GFR rather than those with low GFR. These discoveries might offer some help for the therapy of Chinese older patients with cardiovascular/renal diseases.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Asian People; Aspirin; Calcium Channel Blockers; Clopidogrel; Coronary Artery Disease; Digoxin; Drug Utilization; Female; Glomerular Filtration Rate; Heart Failure; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Nitrates

Higher levels of resting heart rate (HR) have been associated with sudden cardiac death (SCD) but mechanisms are poorly understood. We hypothesized that severe left ventricular systolic dysfunction (LVSD) and HR-modulating drugs explain the HR-SCD relationship.. To evaluate the relationship between HR, severe LVSD, HR-modulating drugs, and SCD in the community by using a case-control approach.. From the ongoing Oregon Sudden Unexpected Death Study, SCD cases (n = 378) aged ≥35 years and with electrocardiogram-documented resting HR were compared to 378 age- and gender-matched control subjects with coronary artery disease (mean age 68 ± 13 years; 69% man). Associations with SCD were assessed by using multivariable logistic regression.. Mean resting HR was significantly higher among SCD cases compared to controls (7.5 beats/min difference; P < .0001). HR was a significant determinant of SCD after adjustment for significant comorbidities and medications (odds ratio for 10 beats/min increase 1.26; 95% confidence interval 1.14-1.38; P < .0001). After considering LVSD, resting HR was slightly attenuated but remained significantly associated with SCD (P = .005). In addition to diabetes and digoxin as well as pulmonary and renal disease, LVSD was also independently associated with SCD (odds ratio 1.79; 95% confidence interval 1.11-2.87; P = .02).. Contrary to expectations, the significant relationship between increased resting HR and SCD persisted even after adjustment for LVSD and HR-modulating drugs. These findings suggest a potential role for additional novel interventions/therapies that modulate autonomic tone.

Topics: Aged; Cardiotonic Agents; Case-Control Studies; Coronary Artery Disease; Death, Sudden, Cardiac; Diabetes Mellitus; Digoxin; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged; Risk Factors; Ventricular Dysfunction, Left

Topics: Aged; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Artery Disease; Digoxin; Drug-Eluting Stents; Fatigue; Humans; Male; Physician-Patient Relations

Clinical autopsy rate have been declining since the 1950s, but it remains a useful investigation tool.. Through six examples of our experience, we underline its interest for clinical, didactic and public health purposes.. We try to understand the reasons for its decline and, as demonstrated, it can be attributed to a number of factors. These need to be addressed in order to reassert the status of the autopsy as an investigation and audit tool which is crucial to the future effectiveness of modern medicine.

Topics: Adult; Aged; Atherosclerosis; Atrial Fibrillation; Autopsy; Cardiotonic Agents; Casuistry; Cause of Death; Coronary Artery Disease; Coronary Thrombosis; Diagnosis, Differential; Digoxin; Education, Medical; Female; France; Hallucinations; Hospitals, University; Humans; Male; Marfan Syndrome; Meningitis, Listeria; Meningitis, Pneumococcal; Middle Aged; Myocardial Infarction

This study evaluated the effects of digoxin infusion (0.014 mg/kg in 10 min i.v.) on large coronary arteries measured by quantitative digital angiography. Twenty-two patients (aged 47 +/- 12), divided in 3 groups were studied. The effects of digoxin infusion (after 10 and 20 min) and sublingual administration of isosorbide dinitrate were investigated in Group I (patients with angiographically normal coronary arteries, n = 9) and in Group II (patients with atherosclerotic coronary arteries, n = 8). In Group III (n = 5) to determine whether or not the effects of digoxin were mediated by activation of alpha-adrenergic receptors, coronary angiographies were performed after alpha-adrenoceptor blockade (phentolamine 0.11 mg/kg, i.v.). In Group I, 10 min after the end of digoxin infusion, cross-sectional area decreased from 7.7 +/- 4.1 mm2 to 6.0 +/- 2.2 mm2, and after 20 min to 5.6 +/- 2.6 mm2 (p < 0.05). Isosorbide dinitrate reverted digoxin-induced vasoconstriction as cross-sectional area increased to 8.5 +/- 3.4 mm2 (NS versus baseline). By 20 min after digoxin infusion heart rate was significantly reduced from 79 +/- 16 to 74 +/- 13 b/min (p < 0.01). Peripheral vascular resistances increased significantly 10 min after digoxin infusion (from 1396 +/- 693 to 1693 +/- 984 dyne*s*cm-5, p < 0.05), whereas cardiac output did not change. In Group II, minimal stenosis diameter decreased significantly 20 min after digoxin infusion from 1.6 +/- 0.5 mm to 1.4 +/- 0.5 mm (p < 0.05). Again, isosorbide dinitrate reverted digoxin-induced vasoconstriction as minimal stenosis diameter increased (NS versus control).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Analysis of Variance; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Digoxin; Female; Hemodynamics; Humans; Male; Middle Aged; Receptors, Adrenergic, alpha; Reference Values; Vasoconstriction

This study evaluated the effect of bolus infusion of digoxin (0.014 mg/kg in 10 minutes, intravenously) on large coronary arteries measured by quantitative digital angiography. Twenty-two patients (mean age +/- standard deviation 47 +/- 12 years) divided into 3 groups were studied. The effects of digoxin infusion (after 10 and 20 minutes) and sublingual administration of isosorbide dinitrate were investigated in group I (patients with angiographically normal coronary arteries, n = 9) and in group II (patients with atherosclerotic coronary arteries, n = 8). To determine whether the effects of digoxin were mediated by activation of alpha-adrenergic receptors, coronary angiography was performed in group III after alpha-adrenoceptor blockade (phentolamine 0.11 mg/kg, intravenously) (n = 5). Ten minutes after the end of digoxin infusion, the cross-sectional area decreased from 7.7 +/- 4.1 to 6.0 +/- 2.2 mm2, and after 20 minutes to 5.6 +/- 2.6 mm2 (p less than 0.05) in group I. Isosorbide dinitrate reverted digoxin-induced vasoconstriction as cross-sectional area increased to 8.5 +/- 3.4 mm2 (p = not significant versus baseline). Twenty minutes after digoxin infusion, heart rate significantly decreased from 79 +/- 16 to 74 +/- 13 beats/min (p less than 0.01). Ten minutes after digoxin infusion, peripheral vascular resistance increased significantly from 1,396 +/- 693 to 1,693 +/- 984 dynes.s.cm-5 (p less than 0.05), whereas cardiac output did not change. Twenty minutes after digoxin infusion, minimal stenosis diameter decreased significantly from 1.6 +/- 0.5 to 1.4 +/- 0.5 mm (p less than 0.05) in group II.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Angiography, Digital Subtraction; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Digoxin; Female; Humans; Isosorbide Dinitrate; Male; Middle Aged; Phentolamine; Receptors, Adrenergic, alpha; Vasoconstriction