Digoxin significantly improves all-cause mortality in atrial fibrillation patients with severely reduced left ventricular systolic function (original) (raw)
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Digoxin and mortality in atrial fibrillation: a prospective cohort study
European Journal of Clinical Pharmacology, 2007
Objective The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study showed that rhythm-control treatment of patients with atrial fibrillation (AF) offered no survival advantage over a rate-control strategy. In a subgroup analysis of that study, it was found that digoxin increased the death rate [relative risk (RR)= 1.42), but it was suggested that this may have been attributable to prescription of digoxin for patients at greater risk of death, such as those with congestive heart failure (CHF). No study has investigated a priori the effect of digoxin on mortality in patients with AF. This study aimed to address this question. Methods Using data from the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA), we studied the 1-year mortality among patients admitted to coronary care units with AF, CHF, or AF+CHF with or without digoxin (n=60,764) during 1995-2003. Adjustment for differences in background characteristics and other medications and treatments was made by propensity scoring. Results Twenty percent of patients with AF without CHF in this cohort were discharged with digoxin. This group had a higher mortality rate than the corresponding group not given digoxin [adjusted RR 1.42 (95% CI 1.29-1.56)], whereas no such difference was seen among patients with CHF with or without AF, although these patients had a nearly three-times higher mortality. Conclusion The results suggest that long-term therapy with digoxin is an independent risk factor for death in patients with AF without CHF.
Journal of the American Heart Association, 2017
Digoxin is widely used in patients with atrial fibrillation despite the lack of randomized controlled trials. Observational studies report conflicting results regarding its association with mortality, perhaps because of residual confounding by the presence of heart failure (HF). In the ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) trial, clinical outcomes of patients with atrial fibrillation with and without HF were examined by baseline digoxin use during a median follow-up of 2.8 years. HF was defined at baseline as prior or current clinical stage C or D HF. Of 21 105 patients enrolled, 6327 (30%) were treated with digoxin at baseline. Among patients without HF (n=8981), digoxin use (20%) was independently associated with sudden cardiac death (adjusted hazard ratio, 1.51; 95% CI, 1.10-2.08), with no significant interaction by age, sex, left ventricular ejection fraction, renal function, o...
Journal of Clinical Pharmacy and Therapeutics, 2016
What is known and objective: Although inappropriate use of digoxin has been described in various populations, a real-world evaluation of patterns of digoxin prescription has not been well studied in patients with atrial fibrillation (AF). The aim of this study was to identify prevalence, indications and appropriateness of digoxin use in the general population of patients with non-valvular AF (NVAF) in Turkey. Methods: We included and classified patients from the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke prevention strategies in Turkey) study, a prospective registry including 6273 patients with NVAF, on the basis of digoxin use. After excluding the data of 73 patients whose medical history about digoxin use or left ventricle function was absent, 6200 patients were included for the final analysis. Digoxin use was considered inappropriate if patients did not have left ventricular systolic dysfunction or symptomatic heart failure (HF). Results and discussion: Digoxin was used in 1274 (20Á5%) patients. Patients treated with digoxin were older (71Á4 AE 9Á8 years vs. 69Á2 AE 10Á9 years, P < 0Á001), more likely to be female (58Á8% vs. 55Á9%, P = 0Á019) and had more common comorbidities such as HF (40Á2% vs. 17Á4%), diabetes (26Á4% vs. 21Á1%), coronary artery disease (35Á3 vs. 27Á6%) and persistent/ permanent AF (93Á4% vs. 78Á4%; P < 0Á001 for each comparison). Of the 1274 patients, the indication of digoxin use was considered inappropriate in 762 (59Á8%). What is new and conclusion: Our findings show that nearly onefifth of the patients with NVAF were on digoxin therapy and nearly 60% of these patients were receiving digoxin with inappropriate indications in a real-world setting.
International Journal of Cardiology, 2015
Background: Some evidences suggest that the use of digoxin may be harmful inatrial fibrillation (AF) patients. The aim of the study was to investigate in a "real world" of AF patients receiving vitamin K antagonists (VKAs), the relationship between digoxin use and mortality. Methods: Prospective single-center observational study including 815 consecutive non-valvular AF patients treated with VKAs. Total mortality was the primary outcome of the study. We also performed a sub-analysis considering only cardiovascular (CV) deaths. Time in therapeutic range (TTR) was used for anticoagulation quality. Results: Median follow-up was 33.2 months (2460 person-years); 171 (21.0%) patients were taking digoxin. Compared to those without, patients on digoxin were older (p = 0.007), with a clinical history of HF (p b 0.001) and at higher risk of thromboembolic events (p b 0.001). No difference in TTR between the two groups was registered (p = 0.598). During the follow-up, 85 deaths occurred: 47 CV and 38 non-CV deaths; 35 deaths occurred in digoxin users (20.6%). A significant increased rate of total mortality was observed in digoxin-treated patients (p b 0.001). Multivariable analysis showed that digoxin was associated with total mortality (hazard ratio [HR]: 2.224, p b 0.001) and CV death (HR: 4.686, p b 0.001). A propensity score-matched analysis confirmed that digoxin was associated with total mortality (HR: 2.073, p = 0.0263) and CV death (HR: 4.043, p = 0.004). Conclusions: In AF patients on good anticoagulation control with VKAs, digoxin use was associated with a higher rate of total and CV mortality.
Archives of Cardiovascular Diseases, 2012
Background. -Digoxin is highly potent and efficacious for treatment of heart failure (HF) and/or atrial fibrillation (AF) yet compliance is often poor. Aims. -To examine prevalence rates of non-compliance with digoxin; variations between clinical settings, types of non-compliance and methods of detection; and potential factors influencing non-compliance with digoxin. Methods. -This was a systematic review and meta-analysis of prospective observational studies of non-compliance with digoxin in patients with HF and/or AF, published in English. The studies were identified through these bibliographic databases: MEDLINE, EMBASE, CINAHL, IPA and Cochrane CENTRAL. Subgroup analysis examined the influence of clinical settings, types of non-compliance and methods of detection.