Digoxin and Mortality Risk in Atrial Fibrillation | Journal Scan

Study Questions:

Does digoxin worsen outcomes in patients with atrial fibrillation (AF)?


This prospective, multicenter, registry study included 9,619 patients (mean age 75 years, 43% females, heart failure [HF] in 32.9%) with AF. The patients were seen every 6 months in an outpatient clinic for a mean of 22 months. Digoxin use was reported either upon enrollment or during follow-up in 29.6% of patients. The primary outcome of the study was all-cause death.


Digoxin use at the time of enrollment was not a significant independent predictor of mortality, either in patients with HF (hazard ratio [HR], 1.04) or without HF (HR, 1.22). The initiation of treatment with digoxin during follow-up in patients with HF also was not an independent predictor of mortality (HR, 1.05). However, among patients without HF, the initiation of digoxin during follow-up was independently associated with double the risk of all-cause mortality (HR, 1.99).


The use of digoxin in a subset of patients with AF without HF may be associated with a higher risk of death. Digoxin has a neutral effect on survival in patients with AF and HF.


A number of studies have addressed the question of whether digoxin is associated with a higher risk of death in patients with AF. This study represents one more observational study that does not provide a definitive answer. A recent meta-analysis (Vamos M, et al., Eur Heart J 2015;May 4:[Epub ahead of print]) concluded that digoxin in patients with AF is associated with a higher risk of death. Therefore, it may be appropriate to avoid the use of digoxin in patients with AF whenever possible.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Ambulatory Care Facilities, Arrhythmias, Cardiac, Anticoagulants, Atrial Fibrillation, Digoxin, Follow-Up Studies, Heart Conduction System, Heart Failure, Mortality, Prospective Studies, Registries, Risk, Secondary Prevention, Survival

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