Safety profile of intravenous digoxin in Chinese patients with acute heart failure with reduced ejection fraction: a small-scale prospective cohort study
Background: Adverse effects of intravenous digoxin vary from patients and disease status, which should be closely monitored.Aims: To explore the safety profile of intravenous digoxin in acute heart failure with reduced ejection fraction (HFrEF) among Chinese patients.Methods: A clinical prospective,...
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| Format: | Article |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1291896/full |
| _version_ | 1827763167450628096 |
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| author | Xintian Liu Xintian Liu Haojie Zhang Wenlin Cheng Qingkun Fan Zhibing Lu Xuan Zheng Gangcheng Zhang |
| author_facet | Xintian Liu Xintian Liu Haojie Zhang Wenlin Cheng Qingkun Fan Zhibing Lu Xuan Zheng Gangcheng Zhang |
| author_sort | Xintian Liu |
| collection | DOAJ |
| description | Background: Adverse effects of intravenous digoxin vary from patients and disease status, which should be closely monitored.Aims: To explore the safety profile of intravenous digoxin in acute heart failure with reduced ejection fraction (HFrEF) among Chinese patients.Methods: A clinical prospective, single-center, single-arm, open-label exploratory clinical trial was performed in patients with acute HFrEF at Wuhan Asia Heart Hospital. A fixed dose of 0.5 mg digoxin was used intravenously once per day for 3 days. The normalized dosage of digoxin (NDD), toxic serum digoxin concentration (SDC), and adverse reactions of intravenous digoxin were recorded.Results: A total of 40 patients were recruited in the study. The SDC increased from 1.03 ± 0.34 ng/mL to 1.95 ± 0.52 ng/mL during treatment. 50% (20/40) patients reached a toxic SDC of 2.0 ng/mL, and toxic effects were seen in 30% (12/40) patients. Estimated glomerular filtration rate (eGFR) < 60 mL/min [HR: 5.269; 95% CI: 1.905–14.575, p = 0.001], NDD ≥7 μg/kg [HR: 3.028; 95% CI: 1.119–8.194, p = 0.029], and ischemic cardiomyopathy [HR: 2.658; 95% CI: 1.025–6.894, p = 0.044] were independent risk factors for toxic SDC. Toxic SDC was effectively identified [area under the receiver operating characteristic (ROC) curve = 0.85, p < 0.001] using this model, and patients would have a higher risk of toxicity with more risk factors.Conclusion: Intravenous digoxin of 0.5 mg was safe and effective for initial dose but not suitable for maintenance treatment in Chinese patients with acute HFrEF. Patients who had lower eGFR, received higher NDD, and had ischemic cardiomyopathy should be closely monitored to avoid digoxin toxicity. |
| first_indexed | 2024-03-11T10:47:22Z |
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| id | doaj.art-b87cc03745664a0090445ba43f20998d |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-03-11T10:47:22Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-b87cc03745664a0090445ba43f20998d2023-11-14T02:15:31ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122023-11-011410.3389/fphar.2023.12918961291896Safety profile of intravenous digoxin in Chinese patients with acute heart failure with reduced ejection fraction: a small-scale prospective cohort studyXintian Liu0Xintian Liu1Haojie Zhang2Wenlin Cheng3Qingkun Fan4Zhibing Lu5Xuan Zheng6Gangcheng Zhang7Center of Structural Heart Disease, Zhongnan Hospital of Wuhan University, Wuhan, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, ChinaCenter of Structural Heart Disease, Zhongnan Hospital of Wuhan University, Wuhan, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, ChinaLaboratory Medicine, Wuhan Asia Heart Hospital, Wuhan University of Science and Technology, Wuhan, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, ChinaCenter of Structural Heart Disease, Zhongnan Hospital of Wuhan University, Wuhan, ChinaCenter of Structural Heart Disease, Zhongnan Hospital of Wuhan University, Wuhan, ChinaBackground: Adverse effects of intravenous digoxin vary from patients and disease status, which should be closely monitored.Aims: To explore the safety profile of intravenous digoxin in acute heart failure with reduced ejection fraction (HFrEF) among Chinese patients.Methods: A clinical prospective, single-center, single-arm, open-label exploratory clinical trial was performed in patients with acute HFrEF at Wuhan Asia Heart Hospital. A fixed dose of 0.5 mg digoxin was used intravenously once per day for 3 days. The normalized dosage of digoxin (NDD), toxic serum digoxin concentration (SDC), and adverse reactions of intravenous digoxin were recorded.Results: A total of 40 patients were recruited in the study. The SDC increased from 1.03 ± 0.34 ng/mL to 1.95 ± 0.52 ng/mL during treatment. 50% (20/40) patients reached a toxic SDC of 2.0 ng/mL, and toxic effects were seen in 30% (12/40) patients. Estimated glomerular filtration rate (eGFR) < 60 mL/min [HR: 5.269; 95% CI: 1.905–14.575, p = 0.001], NDD ≥7 μg/kg [HR: 3.028; 95% CI: 1.119–8.194, p = 0.029], and ischemic cardiomyopathy [HR: 2.658; 95% CI: 1.025–6.894, p = 0.044] were independent risk factors for toxic SDC. Toxic SDC was effectively identified [area under the receiver operating characteristic (ROC) curve = 0.85, p < 0.001] using this model, and patients would have a higher risk of toxicity with more risk factors.Conclusion: Intravenous digoxin of 0.5 mg was safe and effective for initial dose but not suitable for maintenance treatment in Chinese patients with acute HFrEF. Patients who had lower eGFR, received higher NDD, and had ischemic cardiomyopathy should be closely monitored to avoid digoxin toxicity.https://www.frontiersin.org/articles/10.3389/fphar.2023.1291896/fullacute heart failure with reduced ejection fractionintravenous digoxindigoxin toxicityserum digoxin concentration (SDC)safety evaluation |
| spellingShingle | Xintian Liu Xintian Liu Haojie Zhang Wenlin Cheng Qingkun Fan Zhibing Lu Xuan Zheng Gangcheng Zhang Safety profile of intravenous digoxin in Chinese patients with acute heart failure with reduced ejection fraction: a small-scale prospective cohort study Frontiers in Pharmacology acute heart failure with reduced ejection fraction intravenous digoxin digoxin toxicity serum digoxin concentration (SDC) safety evaluation |
| title | Safety profile of intravenous digoxin in Chinese patients with acute heart failure with reduced ejection fraction: a small-scale prospective cohort study |
| title_full | Safety profile of intravenous digoxin in Chinese patients with acute heart failure with reduced ejection fraction: a small-scale prospective cohort study |
| title_fullStr | Safety profile of intravenous digoxin in Chinese patients with acute heart failure with reduced ejection fraction: a small-scale prospective cohort study |
| title_full_unstemmed | Safety profile of intravenous digoxin in Chinese patients with acute heart failure with reduced ejection fraction: a small-scale prospective cohort study |
| title_short | Safety profile of intravenous digoxin in Chinese patients with acute heart failure with reduced ejection fraction: a small-scale prospective cohort study |
| title_sort | safety profile of intravenous digoxin in chinese patients with acute heart failure with reduced ejection fraction a small scale prospective cohort study |
| topic | acute heart failure with reduced ejection fraction intravenous digoxin digoxin toxicity serum digoxin concentration (SDC) safety evaluation |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1291896/full |
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