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Are coronary patients at higher risk with digoxin therapy? An ongoing controversy
H Reicher-Reiss1, M Jonas, V Boyko
1Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.
Insights
Digoxin use in chronic coronary artery disease patients post-myocardial infarction is linked to higher overall and cardiac mortality. This study suggests a 30-50% increased risk, potentially due to arrhythmias.
Area of Science:
- Cardiology
- Clinical Pharmacology
Background:
- Conflicting evidence exists on digoxin safety in acute myocardial infarction survivors.
- Digoxin is a cardiac glycoside used for heart failure and arrhythmias.
Purpose of the Study:
- To investigate the association between digoxin therapy and mortality in patients with chronic coronary artery disease (CAD) after surviving an acute myocardial infarction (MI).
Main Methods:
- Analysis of data from 8173 patients screened for the Bezafibrate Infarction Prevention (BIP) trial.
- Patients had survived an acute MI at least 6 months prior.
- Comparison of 3-year overall and cardiac mortality between digoxin users and non-users.
Main Results:
- Overall mortality was 22.4% in digoxin users versus 8.3% in non-users.
- Cardiac mortality was 16.2% in digoxin users versus 4.9% in non-users.
- Increased risk associated with digoxin remained significant across various patient subgroups.
Conclusions:
- Digoxin administration in chronic CAD patients post-MI is associated with a 30-50% increased risk of overall and cardiac mortality.
- Potential increased risk of arrhythmias in ischemic heart disease patients may explain this association.
- Findings suggest caution when prescribing digoxin to this patient population.
Abstract:
Previous reports have yielded contradictory conclusions regarding the safety of digoxin therapy in patients with acute myocardial infarction. The purpose of our study was to determine whether digoxin therapy is associated with increased mortality in patients with chronic coronary artery disease. We analyzed data from 8173 patients who were screened for participation in the Bezafibrate Infarction Prevention (BIP) trial and who survived an acute myocardial infarction at least 6 months prior to the study. Three-year overall mortality of the 451 (15.5%) patients receiving digoxin (according to the judgement of their treating physician) at the time of screening for BIP participation, was 22.4% compared to 8.3% in the patients who did not receive digoxin. Cardiac mortality was 16.2% in the digoxin-treated group, compared to 4.9% in the non-treated patients. The increased risk associated with digoxin remained statistically significant when patients were stratified according to sex, age groups, functional capacity and the presence of hypertension, diabetes or angina. The administration of digoxin to survivors of an acute myocardial infarction in the chronic phase of their disease, is statistically associated with a 30-50% increase in the risk of overall and cardiac mortality during long-term follow-up. A propensity of increased risk of arrhythmias in ischemic coronary patients may explain this finding.