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NICE atrial fibrillation guidance branded 'dangerous'

Atrial fibrillation guidance from NICE has been branded ‘potentially dangerous' with claims it ignores traditional practice.

In June last year NICE is-sued guidance sidelining digoxin as first-line treatment for rate control in atrial fibrillation in favour of beta blockers or rate-limiting calcium channel blockers.

But cardiologists attacked the switch in the latest BMJ, claiming the advice goes against historical practice and puts patients at risk.

One of the authors Professor Kevin Channer, consultant cardiologist at the Royal Hallamshire Hospital in Sheffield, said he became aware of the guidance after a GP told him he was switching all his patients from digoxin to beta-blocker therapy. ‘Switching is a crazy idea, because many of these patients are elderly and digoxin is very well tolerated, but beta blockers can precipitate heart failure in a cohort of patients,' he said.

He claims the NICE guidance is ‘intrinsically potentially dangerous' and mostly based on opinion rather than evidence. He recommends the combination of digoxin and a beta blocker or calcium channel blocker as first-line treatment in atrial fibrillation. ‘It is safest to start with digoxin first,' he said.

But a member of the NICE guideline development group vigorously defended the new advice.

Professor John Camm, head of cardiac and vascular sciences at St George's Hospital in London told Pulse: ‘Two separate guidelines written independently have come to the same conclusion,' referring to similar guidance from the American Heart Association, the American College of Cardiology and the European Society of Cardiology in 2006.

‘I don't know why they are making such a fuss about it, as the guideline still encourages the use of digoxin in combination with beta blockers and calcium antagonists.'

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