Mortality in heart failure with atrial fibrillation: Role of digoxin and diuretics

Gonzalez-Loyola, Felipe; Abellana, Rosa; Verdú-Rotellar, José María; Rangel, Alejandro Bustamante; Clúa-Espuny, Josep Lluís; Muñoz, Miguel Ángel

doi:10.1111/eci.13014

Cited by 8 publications

(10 citation statements)

References 40 publications

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“…and a study by Whitbeck et al (20) were both based on the same original trial database (Atrial Fibrillation Followup Investigation of Rhythm Management, AFFIRM), thus we only included the former because it had a rigorous analytic methodology and provided data on hospitalization in patients with AF using digoxin compared with those without digoxin. We finally included 29 studies (8-10, 14, 15, 17, 19, 21-42), in which there were 6 new studies (14,15,38,(40)(41)(42) different from previous version of systematic review (Figure 1). And a total of 621,478 patients were included in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

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Effect of Digoxin Therapy on Mortality in Patients With Atrial Fibrillation: An Updated Meta-Analysis

Wang

Luo

et al. 2021

Front. Cardiovasc. Med.

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Background: Whether digoxin is associated with increased mortality in atrial fibrillation (AF) remains controversial. We aimed to assess the risk of mortality and clinical effects of digoxin use in patients with AF.Methods: PubMed, Embase, and the Cochrane library were systematically searched to identify eligible studies comparing all-cause mortality of patients with AF taking digoxin with those not taking digoxin, and the length of follow-up was at least 6 months. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted and pooled.Results: A total of 29 studies with 621,478 patients were included. Digoxin use was associated with an increased risk of all-cause mortality in all patients with AF (HR 1.17, 95% CI 1.13–1.22, P < 0.001), especially in patients without HF (HR 1.28, 95% CI 1.11–1.47, P < 0.001). There was no significant association between digoxin and mortality in patients with AF and HF (HR 1.06, 95% CI 0.99–1.14, P = 0.110). In all patients with AF, regardless of concomitant HF, digoxin use was associated with an increased risk of sudden cardiac death (SCD) (HR 1.40, 95% CI 1.23–1.60, P < 0.001) and cardiovascular (CV) mortality (HR 1.27, 95% CI 1.08–1.50, P < 0.001), and digoxin use had no significant association with all-cause hospitalization (HR 1.13, 95% CI 0.92–1.39, P = 0.230).Conclusion: We conclude that digoxin use is associated with an increased risk of all-cause mortality, CV mortality, and SCD, and it does not reduce readmission for AF, regardless of concomitant HF. Digoxin may have a neutral effect on all-cause mortality in patients with AF with concomitant HF.Systematic Review Registration:https://www.crd.york.ac.ukPROSPERO.

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Section: Resultsmentioning

confidence: 99%

“…The characteristics of studies are summarized in Table 1. There were four studies (15,23,38,42) only included patients with AF with concomitant HF, while one study (32) only included patients with AF without concomitant HF. The remaining 24 studies included patients with AF regardless of concomitant HF.…”

Section: Resultsmentioning

confidence: 99%

Effect of Digoxin Therapy on Mortality in Patients With Atrial Fibrillation: An Updated Meta-Analysis

Wang

Luo

et al. 2021

Front. Cardiovasc. Med.

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“…Besides, exercise training has been shown to improve heart function and prevent some heart diseases [25, 36, 61]. Numerous studies have reported that age-related heart disease is the leading cause of death in the elderly [62–64]. These findings suggest that cardiac function is important for mobility and survival in older individuals.…”

Section: Resultsmentioning

confidence: 99%

“…In young flies, cardiac dSir2 gene had no significant effect on climbing ability, and the reason for this may be that changes in heart function induced by cardiac Sir2 differential expression were not enough to cause hypoxia in tissues such as the brain [57, 58]. Cardiac Sir2 knockdown may contribute to age-related heart disease and lead to death in the elderly [62–64]. In addition, we found that exercise training improved the mobility in cardiac dSir2 differential-expression and old flies.…”

Section: Discussionmentioning

confidence: 99%

The activation of cardiac dSir2-related pathways mediates physical exercise resistance to heart aging in old Drosophila

Wen

Zheng

et al. 2019

Aging

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Cardiac aging is majorly characterized by increased diastolic dysfunction, lipid accumulation, oxidative stress, and contractility debility. The Sir2/Sirt1 gene overexpression delays cell aging and reduces obesity and oxidative stress. Exercise improves heart function and delays heart aging. However, it remains unclear whether exercise delaying heart aging is related to cardiac Sir2/Sirt1-related pathways. In this study, cardiac dSir2 overexpression or knockdown was regulated using the UAS/hand-Gal4 system in Drosophila. Flies underwent exercise interventions from 4 weeks to 5 weeks old. Results showed that either cardiac dSir2 overexpression or exercise remarkably increased the cardiac period, systolic interval, diastolic interval, fractional shortening, SOD activity, dSIR2 protein, Foxo, dSir2, Nmnat, and bmm expression levels in the aging flies; they also notably reduced the cardiac triacylglycerol level, malonaldehyde level, and the diastolic dysfunction index. Either cardiac dSir2 knockdown or aging had almost opposite effects on the heart as those of cardiac dSir2 overexpression. Therefore, we claim that cardiac dSir2 overexpression or knockdown delayed or promoted heart aging by reducing or increasing age-related oxidative stress, lipid accumulation, diastolic dysfunction, and contractility debility. The activation of cardiac dSir2/Foxo/SOD and dSir2/Foxo/bmm pathways may be two important molecular mechanisms through which exercise works against heart aging in Drosophila.

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“…In Metaanalysen konnte bei Patienten mit VHF eine erhöhte Mortalität unter Digitalis nachgewiesen werden [26,27], randomisierte Studiendaten bei Patienten mit VHF und Herzinsuffizienz liegen jedoch nicht vor. Zudem konnte eine erhöhte Mortalität unter Digitalis nicht in allen Analysen bestätigt werden [28,29]. Dennoch sollte der Einsatz von Digitalis zurückhaltend erfolgen, d. h. nur bei therapierefraktärer Tachyarrhythmia absoluta.…”

Section: Therapieunclassified

Herzinsuffizienz und Arrhythmien

Stellbrink

2019

Aktuel Kardiol

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ZusammenfassungDie häufigsten und prognostisch bedeutsamsten Arrhythmien bei der Herzinsuffizienz sind Vorhofflimmern und ventrikuläre Arrhythmien. Pathophysiologisch liegen beiden Arrhythmien eine Aktivierung des neurohumoralen Systems im Rahmen des Remodelings, myokardiale Hypertrophie bzw. Fibrose sowie Änderungen der kardialen Erregungsleitung und der Repolarisation zugrunde. Vorhofflimmern führt zu einer Beeinträchtigung der kardialen Hämodynamik, erhöht die Mortalität und das Risiko für thromboembolische Komplikationen. Die Therapie fokussiert daher auf die Antikoagulation, den Erhalt des Sinusrhythmus bzw. eine Frequenzkontrolle, wenn ein Sinusrhythmus nicht mehr dauerhaft erhalten werden kann. Da die antiarrhythmische Therapie praktisch auf Amiodaron beschränkt ist, spielt die Katheterablation eine zunehmende Rolle, wenn ein Erhalt des Sinusrhythmus das therapeutische Ziel ist. Allerdings ist der Eingriff bei herzinsuffizienten Patienten komplex und sollte in erfahrenen Zentren durchgeführt werden. Auch für ventrikuläre Arrhythmien sind die Möglichkeiten der medikamentösen Therapie beschränkt, daher ist bei Patienten mit ausgeprägter systolischer Herzinsuffizienz oft ein implantierbarer Kardioverter-Defibrillator (ICD) indiziert. Allerdings ist die Datenlage für Patienten mit nicht ischämischer Kardiomyopathie etwas schlechter als für Patienten mit linksventrikulärer Dysfunktion nach Infarkt. Auch bei ventrikulären Tachykardien spielt die Katheterablation bei Herzinsuffizienz eine zunehmende Rolle, besonders bei ischämischen Patienten. Sie kann die Häufigkeit von ventrikulären Tachykardien und ICD-Schocks reduzieren, ein Nutzen hinsichtlich Mortalität ist allerdings nicht nachgewiesen.

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Mortality in heart failure with atrial fibrillation: Role of digoxin and diuretics

Abstract: An excess of mortality in HF patients with AF was found in a large retrospective community-based cohort. Digoxin and diuretics did not affect mortality in HF patients with AF.

Cited by 8 publications

References 40 publications

Effect of Digoxin Therapy on Mortality in Patients With Atrial Fibrillation: An Updated Meta-Analysis

Effect of Digoxin Therapy on Mortality in Patients With Atrial Fibrillation: An Updated Meta-Analysis

The activation of cardiac dSir2-related pathways mediates physical exercise resistance to heart aging in old Drosophila

Herzinsuffizienz und Arrhythmien

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