NICE guidelines on the use of digoxin to slow the heart rate are inconsistent with scientific evidence, doctors argue in the British Medical Journal (BMJ).
In June 2006, NICE published new guidelines for control of heart rate in people with chronic atrial fibrillation.
The guidelines recommend that instead of dioxin, beta blockers and calcium antagonists should be the preferred initial treatment.
However, doctors in Sheffield reviwed 57 studies of heart rate control and now warn that it is safer to start treatment with digoxin first.
The doctors found little evidence that simple treatment with beta blockers or calcium antagonists improve exercise tolerance compared with digoxin.
They say: "We believe the combination of digoxin and a beta blocker or calcium antagonist should be recommended as first line management and we would emphasise that it is safest to start treatment with digoxin first."