TY - JOUR
T1 - Increased mortality among patients taking digoxin - Analysis from the AFFIRM study
AU - Whitbeck, Matthew G.
AU - Charnigo, Richard J.
AU - Khairy, Paul
AU - Ziada, Khaled
AU - Bailey, Alison L.
AU - Zegarra, Milagros M.
AU - Shah, Jignesh
AU - Morales, Gustavo
AU - MacAulay, Tracy
AU - Sorrell, Vincent L.
AU - Campbell, Charles L.
AU - Gurley, John
AU - Anaya, Paul
AU - Nasr, Hafez
AU - Bai, Rong
AU - Di Biase, Luigi
AU - Booth, David C.
AU - Jondeau, Guillaume
AU - Natale, Andrea
AU - Roy, Denis
AU - Smyth, Susan
AU - Moliterno, David J.
AU - Elayi, Claude S.
PY - 2013/5/21
Y1 - 2013/5/21
N2 - AimsDigoxin is frequently used for rate control of atrial fibrillation (AF). It has, however, been associated with increased mortality. It remains unclear whether digoxin itself is responsible for the increased mortality (toxic drug effect) or whether it is prescribed to sicker patients with inherently higher mortality due to comorbidities. The goal of our study was to determine the relationship between digoxin and mortality in patients with AF.Methods and resultsThe association between digoxin and mortality was assessed in patients enrolled in the AF Follow-Up Investigation of Rhythm Management (AFFIRM) trial using multivariate Cox proportional hazards models. Analyses were conducted in all patients and in subsets according to the presence or absence of heart failure (HF), as defined by a history of HF and/or an ejection fraction <40%. Digoxin was associated with an increase in all-cause mortality [estimated hazard ratio (EHR) 1.41, 95% confidence interval (CI) 1.19-1.67, P < 0.001], cardiovascular mortality (EHR 1.35, 95% CI 1.06-1.71, P = 0.016), and arrhythmic mortality (EHR 1.61, 95% CI 1.12-2.30, P = 0.009). The all-cause mortality was increased with digoxin in patients without or with HF (EHR 1.37, 95% CI 1.05-1.79, P = 0.019 and EHR 1.41, 95% CI 1.09-1.84, P = 0.010, respectively). There was no significant digoxin-gender interaction for all-cause (P = 0.70) or cardiovascular (P = 0.95) mortality.ConclusionDigoxin was associated with a significant increase in all-cause mortality in patients with AF after correcting for clinical characteristics and comorbidities, regardless of gender or of the presence or absence of HF. These findings call into question the widespread use of digoxin in patients with AF.
AB - AimsDigoxin is frequently used for rate control of atrial fibrillation (AF). It has, however, been associated with increased mortality. It remains unclear whether digoxin itself is responsible for the increased mortality (toxic drug effect) or whether it is prescribed to sicker patients with inherently higher mortality due to comorbidities. The goal of our study was to determine the relationship between digoxin and mortality in patients with AF.Methods and resultsThe association between digoxin and mortality was assessed in patients enrolled in the AF Follow-Up Investigation of Rhythm Management (AFFIRM) trial using multivariate Cox proportional hazards models. Analyses were conducted in all patients and in subsets according to the presence or absence of heart failure (HF), as defined by a history of HF and/or an ejection fraction <40%. Digoxin was associated with an increase in all-cause mortality [estimated hazard ratio (EHR) 1.41, 95% confidence interval (CI) 1.19-1.67, P < 0.001], cardiovascular mortality (EHR 1.35, 95% CI 1.06-1.71, P = 0.016), and arrhythmic mortality (EHR 1.61, 95% CI 1.12-2.30, P = 0.009). The all-cause mortality was increased with digoxin in patients without or with HF (EHR 1.37, 95% CI 1.05-1.79, P = 0.019 and EHR 1.41, 95% CI 1.09-1.84, P = 0.010, respectively). There was no significant digoxin-gender interaction for all-cause (P = 0.70) or cardiovascular (P = 0.95) mortality.ConclusionDigoxin was associated with a significant increase in all-cause mortality in patients with AF after correcting for clinical characteristics and comorbidities, regardless of gender or of the presence or absence of HF. These findings call into question the widespread use of digoxin in patients with AF.
KW - Arrhythmias
KW - Atrial fibrillation
KW - Congestive heart failure
KW - Digoxin
KW - Mortality
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U2 - 10.1093/eurheartj/ehs348
DO - 10.1093/eurheartj/ehs348
M3 - Article
C2 - 23186806
AN - SCOPUS:84878304958
SN - 0195-668X
VL - 34
SP - 1481
EP - 1488
JO - European Heart Journal
JF - European Heart Journal
IS - 20
ER -