Simply amazing to see the clinical and the QoL improvements noted with #Digoxin in the RATE-AF trial presented at #ESCCongress2020. Among medicine residents, I would attribute less use of digoxin mostly to the problems with it when patients have renal derangement.

As medicine residents, at least a quarter of our in-patient team list, sometimes the entire census, is patients with #heartfailure. We have been time and again told not to initiate digoxin or even stop it due to lower heart rates without objective evidence.

The RATE-AF trial should atleast help us consider/talk about initiation of digoxin, which would be a step higher than the current status it enjoys as a “drug of harm”. I for one will certainly be bringing this up whenever I have a chance, especially in clinic.

And it is not just with #digoxin, and not just for #heartfailure. It is literally our job as medicine residents to keep up with latest RCTs, meta-analyses and guidelines, while working long hours and maybe feeing somewhat under-appreciated, to ultimately improve patient outcomes.

The new ESC guidelines on NSTE-ACS, and AF, and recent trials like DAPA-HF/CKD, EMPEROR, EAST-AFNET 4, and the relatively older REDUCE-it/EVAPORATE, REVERSE-AF, among so many other trials and meta-analyses offer medicine residents the chance to have a more profound impact on...

our patient’s lives directly and indelibly, possibly helping them live longer with an improved quality of life. HFpEF patients, think of amyloidosis! HF patients on GDMT, but still with a wide QRS, push for CRT-P! Medication reconciliation is usually an arduous task for us...

on discharge, but it is the most important thing to reduce readmissions and improve quality of life. I hope us residents get support from objective data, so that we are more comfortable with initiating medications on admission without waiting for a word from the consult service.

It’s a multidisciplinary effort, coordinated between inpatient pharmacists, consult service, outpatient primary care provider, arranging outpatient follow-up. Frequently the need for this coordination falls on residents. Everything is a learning opportunity.

This thread ended up longer than I intended it to be, however I just want to thank all the medicine residents for all that they do. Everything from admission to discharge is frequently upon us, and we need all the tools we can get to achieve the best patient care possible.

There’s more to #heartfailure than #mortalityreduction. There’s more to #AtrialFibrillation than #ratecontrol and #apixaban. There’s nothing more important in medicine than #prevention.

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