Analysis of Digoxin-Associated Mortality | Journal Scan

Study Questions:

Does digoxin increase the risk of death in patients with atrial fibrillation (AF) or congestive heart failure (CHF)?


This was an analysis of 19 studies that investigated the effect of digoxin on mortality in patients with AF (nine studies), CHF (seven studies), or both AF and CHF (three studies). Only one of the studies was a randomized controlled trial, and the others were prospective or retrospective observational studies. There were a total of 235,047 patients with AF and 91,379 patients with CHF in these studies. The mean duration of follow-up was 2.57 years.


Based on a pooled analysis of the 19 studies, treatment with digoxin was associated with a statistically significant 21% increase in the relative risk of all-cause mortality. The relative risk of mortality associated with digoxin use was 29% higher among AF patients and 14% higher among CHF patients.


The use of digoxin is associated with a heightened risk of all-cause mortality, more so in patients with AF than in patients with CHF.


The literature dealing with the effect of digoxin on mortality has been confusing, especially among patients with AF. For example, two different post hoc analyses (Eur Heart J 2013;34:1489-97, and Eur Heart J 2013;34:1481-8) of exactly the same database (AFFIRM) came to opposite conclusions. This meta-analysis is useful because it showed that digoxin was associated with a similar increase in mortality risk regardless of which of the two conflicting studies was used in the analysis. Particularly in light of the very modest efficacy of digoxin for rate control in patients with AF, it would seem prudent to avoid its use.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Arrhythmias, Cardiac, Anti-Arrhythmia Agents, Atrial Fibrillation, Cardiovascular Diseases, Digoxin, Follow-Up Studies, Heart Failure, Mortality, Prospective Studies, Retrospective Studies, Risk

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