Questions about Digoxin
We think it would be prudent to get a balanced report on the latest on Digoxin and it’s links to Deaths with people with Atrial Fibrillation which is a heart rhythm condition as these reports tend to have a habit of spreading like a wild fire and by the time you hear of it the message has been put on the grapevine and the real messages have fallen off the cliff!
The study, which was published online in the European Heart Journal on Nov. 27, 2012, showed that patients who took digoxin who had atrial fibrillation (AF) died in significant numbers whilst on the medication.
Digoxin is made from an extract from the foxglove plant used on patients who have AF and heart failure. Theoretically, it makes the heart beat stronger and more regularly. It is notoriously hard to use because there is a narrow dose range between where it is helpful and when it can cause harm. High doses have been seen to increase death in patients.
For the study, researchers looked at data from 4,060 AF patients who took digoxin before or during the 3.5 year study. The subjects had all enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) to determine any affects digoxin had on increased death rates.
Digoxin was associated with a 41% increase in deaths from any cause, after controlling for other factors. Patients who took digoxin also had a 35 percent increase in deaths from cardiovascular causes, and a 61 percent increase in deaths from arrhythmias, or problems with heart rate.
“These results mean that among AF patients taking digoxin compared to those not on digoxin in the AFFIRM trial, within five years one additional patient out of six will die from any cause, one additional patient out of eight will die from cardiovascular causes, and one additional patient out of 16 will die from arrhythmias,” Samy Claude Elayi, associate professor of medicine at the Gill Heart Institute, University of Kentucky, in Lexington said in a press release.
Elayi added that the results show that widespread use of dioxin may be detrimental to patients who are suffering from AF. However, the findings do not show that the medication is bad for everyone he pointed out to Reuters.
“But in patients that have no heart failure and (have) atrial fibrillation, I think there is no reason to use this drug as a first line,” Elayi said.
Dr. Ali Ahmed, who has studied digoxin at the University of Alabama at Birmingham, told Reuters in a later statement that the study was flawed because it was looking for problems caused by digoxin and did not assign people blindly to the study. He said other “…other patient diseases may have caused the deaths.
“This should be taken with extreme caution, because of the potential for confounding and bias from a variety of sources,” Ahmed, who wasn’t involved in the new research, said.
Natasha Stewart, senior cardiac nurse at the British Heart Foundation (BHF), added to the BBC that while digoxin isn’t the first medication of choice in the U.K., some patients are taking it — and there are plenty of benefits for AF and heart failure patients.
“Before we jump to any conclusions about the dangers of the drug, we’d need to see further research into what might be causing these increased risks,” she said. “Patients who are prescribed digoxin should not stop taking their meds without discussing their concerns with their doctor.”
I think the last statement says it all really and it is important that if you are concerned that you should discuss your concerns with your Doctor or Heart Failure Nurse and not change your medication in anyway unless directed to do so.
Heart Failure and memory loss link
Heart failure has been linked to detrimental changes in the brain, says new research published recently in the European Heart Journal. As heart failure has been linked to depression and cognitive impairment, Professor Osvaldo Almeida of the University of Western Australia, and colleagues investigated whether this is specifically due to the heart failure itself, or sanother factor. They analysed data on 35 heart failure patients, 56 ischemic heart disease patients without heart failure, and 64 healthy people with neither condition. All were aged 45 years or above and had no obvious cognitive impairment. MRI scans of the participants’ brains were assessed. This is the first study of cognitive changes in heart failure to include patients with ischemic heart disease.
Participants with heart failure had a lower volume of grey matter in many areas of the brain than the other two groups. These patients also had lower scores on short- and long-term memory, had longer reaction speeds, and took longer to complete a reasoning task. Professor Almeida explains, “What we found in this study is that both ischemic heart disease and heart failure are associated with a loss of cells in certain brain regions that are important for the modulation of emotions and mental activity. Such a loss is more pronounced in people with heart failure.
Health professionals and patients need to be aware that problems caused by heart disease are not limited to the heart.” In their paper, the researchers conclude, “Adults with heart failure have worse immediate and long-term memory and psychomotor speed than controls without ischemic heart disease.” This could make it more difficult for patients to comply with complicated treatment regimes, they warn, stating, “Our findings are consistent with the possibility that patients with heart failure may have trouble following complex management strategies, and, therefore, treatment messages should be simple and clear.”
They add that further studies will have to be done to uncover the process by which heart failure leads to loss of brain cells, to see whether the problems become worse over time, and to discover whether patients could benefit from cognitive rehabilitation.
Responding to the study, Dr. Christiane Angermann and colleagues at the University of Wurzburg, Germany, say that links between cardiovascular disease and dementia have been observed for decades. In fact, the label “cardiogenic dementia” was first used in 1977. Smaller studies on humans have investigated the issue, with inconsistent results. A few animal studies have also been carried out, and these studies showed changes to the brain after a heart attack. Another potential cognitive problem among heart failure patients is an inability to decide what to do if their condition changes. For example, a patient who has a cognitive problem and experiences sudden weight gain may not think to notify their physician. Their condition could worsen over time, resulting in an avoidable trip to the emergency room.
Richard S. Isaacson, MD, a neurologist at the University of Miami School of Medicine, recommends that patients bring a family member or carer to doctor appointments to help understand the treatment regime and the importance of taking medication consistently. “People with heart failure are going to have trouble understanding because their thinking skills are not as strong as they used to be,” Isaacson says. “They often have multiple medical problems and difficulty understanding what they can do to help themselves.” He supports the use of handouts to explain heart failure and its treatments, to help remind patients of what they need to do and why.
Become a chocoholic… Chocolate and Heart Failure
Now remember don’t over do it! Please note the important point at the bottom which is highlighted… Eating flavanol rich or dark chocolate for a short term may help patients with congestive heart failure, according to a new study in the European Heart Journal. But the effect from long term consumption of flavanol-rich chocolate remains unknown.
Beating Skin Cells
A very interesting piece of research which could transform the way we currently treat Heart Failure
Scientists have for the first time succeeded in taking skin cells from patients with heart failure and transforming them into healthy, beating heart tissue that could one day be used to treat the condition. The researchers, based in Haifa, Israel, said there were still many years of testing and refining ahead. But the results meant they might eventually be able to reprogram patients’ cells to repair their own damaged hearts. “We have shown that it’s possible to take skin cells from an elderly patient with advanced heart failure and end up with his own beating cells in a laboratory dish that are healthy and young – the equivalent to the stage of his heart cells when he was just born,” said Lior Gepstein from the Technion-Israel Institute of Technology, who led the work.
The researchers, whose study was published in the European Heart Journal on Wednesday, said clinical trials of the technique could begin within 10 years. Heart failure is a debilitating condition in which the heart is unable to pump enough blood around the body. It has become more prevalent in recent decades as advances medical science mean many more people survive heart attacks.
Researchers have been studying stem cells from various sources for more than a decade, hoping to capitalise on their ability to transform into a wide variety of other kinds of cell to treat a range of health conditions. There are two main forms of stem cells – embryonic stem cells, which are harvested from embryos, and reprogrammed “human induced pluripotent stem cells” (hiPSCs), often originally from skin or blood.
TISSUES BEATING TOGETHER
Gepstein’s team took skin cells from two men with heart failure – aged 51 and 61 – and transformed them by adding three genes and then a small molecule called valproic acid to the cell nucleus. They found that the resulting hiPSCs were able to differentiate to become heart muscle cells, or cardiomyocytes, just as effectively as hiPSCs that had been developed from healthy, young volunteers who acted as controls for the study. The team was then able to make the cardiomyocytes develop into heart muscle tissue, which they grew in a laboratory dish together with existing cardiac tissue. Within 24 to 48 hours the two types of tissue were beating together, they said. In a final step of the study, the new tissue was transplanted into healthy rat hearts and the researchers found it began to establish connections with cells in the host tissue. “We hope that hiPSCs derived cardiomyocytes will not be rejected following transplantation into the same patients from which they were derived,” Gepstein said. “Whether this will be the case or not is the focus of active investigation.” Experts in stem cell and cardiac medicine who were not involved in Gepstein’s work praised it but also said there was a lot to do before it had a chance of becoming an effective treatment. “This is an interesting paper, but very early and it’s really important for patients that the promise of such a technique is not over-sold,” said John Martin a professor of cardiovascular medicine at University College London. “The chances of translation are slim and if it does work it would take around 15 years to come to clinic.” Nicholas Mills, a consultant cardiologist at Edinburgh University said the technology needs to be refined before it could be used for patients with heart failure, but added: “These findings are encouraging and take us a step closer to … identifying an effective means of repairing the heart.”
We have been saying for a long time that our patients are feeding back to us that their short term memory has been affected since being diagnosed with Heart Failure. We are pleased to see that research has proved their assumptions to be correct.
Heart failure is associated with a decline in mental processes and a loss of grey matter in the brain, new research has found. Scientists at the University of Western Australia say the changes could make it harder for people with heart failure to remember their medication and follow the instructions correctly.
The researchers performed cognitive tests and MRI scans on 35 patients with heart failure, 56 patients with ischaemic heart disease and 64 healthy volunteers. They found that people with heart failure tended to have worse immediate and long-term memory and reaction speeds than healthy people.Heart failure patients also showed changes in areas of the brain that play a role in cognitive and emotional processing.
Professor Osvaldo Almeida said: ‘What we found in this study is that both ischaemic heart disease and heart failure are associated with a loss of cells in certain brain regions that are important for the modulation of emotions and mental activity. ‘Such a loss is more pronounced in people with heart failure, but can also be seen in people with ischaemic heart disease without heart failure.’
The findings are published in the European Heart Journal and could have important implications, as figures from the British Heart Foundation suggest there are more than 27,000 new cases of heart failure each year in the UK.