Digoxin associated with higher mortality in afib patients

Digoxin was associated with a significant increase in all-cause mortality in patients with atrial fibrillation, regardless of gender and whether they had had heart failure, a study found.

To determine the relationship between digoxin and mortality in patients with atrial fibrillation, researchers assessed patients enrolled in the AF Follow-Up Investigation of Rhythm Management (AFFIRM) trial. Analyses were conducted in all patients and in subsets according to the presence or absence of heart failure, as defined by a history of heart failure and/or an ejection fraction less than 40%. Results appeared online Nov. 27 in the European Heart Journal.

Digoxin was associated with an increase in all-cause mortality (estimated hazard ratio [EHR], 1.41; P<0.001), cardiovascular mortality (EHR, 1.35; P=0.016), and arrhythmic mortality (EHR, 1.61; P=0.009). The all-cause mortality was increased with digoxin in patients without or with heart failure (EHR, 1.37; P=0.019 and EHR, 1.41; P=0.010, respectively). There was no significant interaction between digoxin and gender for all-cause (P=0.70) or cardiovascular (P=0.95) mortality.

All-cause mortality was 41% higher in patients with heart failure and 37% higher in patients without heart failure. These findings call into question the widespread use of digoxin in patients with atrial fibrillation, researchers wrote. Recent studies put its use at between 35% and 70% of these patients, despite limited safety data and controversy over its use. The authors noted several limitations to the study, including lack of data on serum digoxin level and kidney function.