Increased All-Cause Mortality Associated With Digoxin Therapy in Patients With Atrial Fibrillation

Chen, Ying; Cai, Xiaoyan; Huang, Weijun; Wu, Y Q; Huang, Yu‐Wen; Hu, Yunzhao

doi:10.1097/md.0000000000002409

Cited by 19 publications

(32 citation statements)

References 41 publications

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“…Our study results are consistent with previous studies, which have demonstrated an increased mortality risk associated with digoxin use among patients with AF 11, 38 . However, many prior studies could not be applied specifically to the African American, socio-economically disadvantaged or other minority populations.…”

Section: Discussionsupporting

confidence: 93%

Effect of Digoxin Use Among Medicaid Enrollees With Atrial Fibrillation

Adedinsewo

Agasthi

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background Recently published analysis of contemporary atrial fibrillation (AF) cohorts showed an association between digoxin and increased mortality and hospitalizations, however other studies have demonstrated conflicting results. Many AF cohort studies did not or were unable to examine racial differences. Our goal was to examine risk factors for hospitalizations and mortality with digoxin use in a diverse real-world AF patient population and evaluate racial differences. Methods and Results We performed a retrospective cohort analysis of claims data for Medicaid beneficiaries, aged 18 – 64 years, with incident diagnosis of AF in 2008 with follow up until December 31, 2009. We created Kaplan Meier curves and constructed multivariable Cox proportional-hazard models for mortality and hospitalization. We identified 11,297 persons with an incident diagnosis of AF in 2008, of those, 1, 401 (12.4%) were on digoxin. Kaplan Meier analysis demonstrated an increased risk of hospitalization with digoxin use overall and within race and heart failure groups. In adjusted models, digoxin was associated with an increased risk of hospitalization (aHR=1.54; 95% CI=1.39 – 1.70) and mortality (aHR=1.50; 95 % CI=1.05 – 2.13). Overall, African Americans had a higher risk of hospitalization but similar mortality when compared to whites regardless of digoxin use. We found no significant interaction between race and digoxin use for mortality (p=0.4437) and hospitalization (p=0.7122). Conclusions Our study demonstrates an overall increased risk of hospitalizations and mortality with digoxin use but no racial/ethnic differences in outcomes were observed. Further studies including minority populations are needed to critically evaluate these associations.

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Section: Discussionsupporting

confidence: 93%

Effect of Digoxin Use Among Medicaid Enrollees With Atrial Fibrillation

Adedinsewo

Agasthi

et al. 2017

Circ: Arrhythmia and Electrophysiology

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“…29,[34][35][36][37][38][39][40]. These findings are incongruous with data in patients with HFrEF plus AF (see below) and the reduction in hospital admissions in HF.…”

mentioning

confidence: 79%

Digoxin: The good and the bad

Ziff

Kotecha

2016

Trends in Cardiovascular Medicine

112

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After 230 years of use, digitalis remains an important and useful therapy for patients with atrial fibrillation, heart failure, and the 30-50 % of patients with both conditions. Although the combination of positive inotropic activity with negative chronotropic effects has been shown to reduce hospital admissions in heart failure, there is a distinct lack of robust trial data, particularly in patients with atrial fibrillation. We recently performed a comprehensive meta-analysis of all digoxin studies and demonstrated a neutral effect on mortality. This contradicts prior observational data that overlook the fact that digitalis is usually given as second-line therapy to the sickest patients. Use of these agents in clinical practice should take account of appropriate dose, serum concentration, drug interactions, and potential side effects. The aim of this review is to evaluate the evidence base for cardiac glycosides and provide a pragmatic guide to their advantages and disadvantages.

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“…In a very recently published meta-analysis, digoxin treatment was associated with a significant increase in allcause mortality after the multivariate adjustment in patients with AF. 23 Despite the growing availability of alternative treatments for AF patients with HF, the use of digoxin in RAMSES study was 20Á5%…”

Section: Discussionmentioning

confidence: 99%

“…When stratified by HF, digoxin therapy was associated with significantly higher mortality in those without HF, but not in those with HF. In a very recently published meta‐analysis, digoxin treatment was associated with a significant increase in all‐cause mortality after the multivariate adjustment in patients with AF …”

Section: Discussionmentioning

confidence: 99%