Developing ways to personalise digoxin treatment

Cardiotonic steroids in patients with atrial fibrillation and heart failure: Quantification, functional effects and personalisation of digoxin therapy

Digoxin is a common treatment for people with atrial fibrillation and heart failure, but it doesn’t always work as well as expected. Dr Pavlovic’s team at the University of Birmingham has previously shown that substances in the blood called cardiotonic steroids can interfere with the action of digoxin. This is possibly because they both work on the same structure in heart cells. Cardiotonic steroids are present in higher amounts in people with heart disease, but the levels vary from one person to another. It is thought that these variations could be why people have different responses to digoxin treatment. In this project, the team will develop new methods to measure cardiotonic steroids in patient blood and will examine their effects on heart cells in the lab and from mice. They will then use these methods to measure cardiotonic steroids in people already taking part in a clinical trial looking at ways to control heart rate. They hope to understand the effects of different cardiotonic steroid levels on heart function in people with or without heart failure, treated with digoxin or other heart rate control treatments. The results could lead to new ways to tell whether people with atrial fibrillation and heart failure would benefit from digoxin and allow doctors to personalise their treatment.