Shirin Hamid
Walsall Healthcare NHS Trust, United Kingdom
Abstract Title:
From Dose to Death, How Safe is Our Digoxin Monitoring?
Biography:
Dr. Shirin Hamid is a senior respiratory and General Internal Medicine trainee in the North West Midlands
deanery, currently based at Walsall Manor Hospital. She is due to complete dual specialty training and
obtain her CCT in November 2026.
Her clinical interests include interventional bronchoscopy and lung cancer, with a strong focus on delivering
compassionate, patient-centred respiratory care. Alongside her clinical practice, Dr. Hamid is passionate
about communication, empathy, and supporting patients through complex respiratory disease pathways.
Outside medicine, she is an accomplished piano enthusiast and values the balance between medicine,
Cardiology 2026
music, and reflective practice.
Research Interests:
Digoxin is a commonly used drug in the management of heart failures; however, invigilation
of its narrow therapeutic window remains inconsistent. Data from US indicate between 18
36 deaths annually from digoxin toxicity carrying a higher mortality rate when compared with
similarly toxicity profile‑ lithium (1‑7 death/annum) and warfarin (0‑2 deaths/annum).
Current UK guidance does not advise for routine digoxin level check but pharmaceutical
guidance suggest trough level 7 days following starting or any dose adjustment, the introduction
of interacting medications, worsening renal function or when toxicity is suspected. It cost about
£150 per test versus £10,000 per DigiFab (antidote) course. This audit assesses adherence to
current guidance on digoxin monitoring.
Digoxin (n=125) and DigiFab (n=3) prescriptions were issued from pharmacy to inpatients
and outpatients between 1 March to 1 September 2025 in a District General Hospital. Their
Electronic medical records were retrospectively reviewed. The mean age is 78.15±13.17years and
56.8% were female. Observed mortality was 26.4%. Mean serum digoxin level was 1.23±0.86 µg/L.
69.6% (n=87) had no recorded digoxin level measurement, at any timepoint. Among those who
had their levels checked, 4% (n=5) were within 7 days, 8% (n=10) within 90 days, and 18.4% (n=23)
more than 90 days. 80.8% of the studied population were prescribed at least one concurrent
potentiator of digoxin toxicity.
Amongst the 43 inpatients with suspected toxicity, 37.2% has no serum digoxin. 39% of those
checked has supratherapeutic level. It would have cost £18,750 to measure digoxin compared to
£170,000 antidote if we have to treat.
It is well established that digoxin toxicity is associated with mortality and morbidity. This study
reveals that there is poor concordance with recommended guidelines; significant proportion
never have digoxin monitoring during their therapeutic timespan. Further work is required to
develop safe yet cost‑effective practice in the form of toxicity prevention.
