Experts criticise NICE AF guidance

NICE guidance on the control of heart rate in people with AF has been criticised for downgrading the use of digoxin.

Writing in the BMJ, cardiologists from The Royal Hallamshire Hospital in Sheffield said NICE guidance published in June 2006 'departed from historical practice' by recommending the use of beta-blockers or rate-limiting calcium antagonists instead of digoxin for initial monotherapy in AF patients.

Using online medical databases, the cardiologists reviewed 57 studies, including 25 randomised double blind controlled trials, assessing digoxin, beta-blockers and calcium antagonists for rate control in chronic AF. Only one showed beta-blockers were better than digoxin in controlling heart rate at rest.

The researchers said: 'The combination of digoxin and a beta-blocker or calcium antagonist should be recommended as first line management.'

BMJ Online 2007

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