Impact of digoxin on risk of death in heart failure patients treated with b-blockers. Results from Polish part of ESC Heart Failure Long-Term Registry

Abstract

Digoxin is associated with increased risk of death in HFrEF patients without AF history receiving the guideline- -directed treatment. Digoxin seems to be employed in patients with worse clinical status, which may at least partially explain its association with increased risk of death.

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

“…Secondly, a slowing of the ventricular response may reflect the use of AVN blocking drugs (e.g. digoxin) that can exert lethal proarrhythmic effects independent of rate slowing . Thirdly, the myocardial fibrotic process in HFpEF may affect the conduction system, which contributes to chronotropic incompetence and can lead to serious bradyarrhythmias and increased mortality if patients are prescribed AVN blocking drugs .…”

“…Conduction system disease requiring pacemaker therapy is common in HFpEF, particularly in those with AF . The rate‐slowing effects of AVN blocking drugs may contribute to their adverse effects on mortality or negate any independent action to prolong survival . Regardless of the mechanism, the totality of evidence raises doubts about the current approach to the use of AVN blocking drugs for rate control when treating AF (and latent HFpEF) in obesity or type 2 diabetes.…”

“…Furthermore, the intensive post‐procedural use of membrane‐active anti‐arrhythmic drugs carries its own risk for proarrhythmia and worsening HF, particularly in patients with AF and an underlying ventricular myopathy (i.e. HFpEF) …”

“…digoxin) that can exert lethal proarrhythmic effects independent of rate slowing. [206][207][208][209] Thirdly, the myocardial fibrotic process in HFpEF may affect the conduction system, 210 which contributes to chronotropic incompetence and can lead to serious bradyarrhythmias and increased mortality if patients are prescribed AVN blocking drugs. 211,212 Conduction system disease requiring pacemaker therapy is common in HFpEF, particularly in those with AF.…”

“…HFpEF). 206,207,224 There is little controlled clinical trial evidence of the effects of catheter ablation in patients with obesity or type 2 diabetes and HFpEF. Nevertheless, it is known that the LA and LV in patients with these two metabolic disorders are typically affected by extensive fibrosis; 225,226 this fibrosis also represents a cardinal feature of both HFpEF and longstanding AF.…”