Digoxin in patients with permanent atrial fibrillation: data from the RACE II study

Area of Science:

• Cardiology
• Pharmacology

Background:

• Previous studies, like the Atrial Fibrillation Follow-up Investigation of Rhythm Management trial, suggested digoxin may increase mortality in atrial fibrillation patients.
• This has led to ongoing research into digoxin's safety profile in cardiovascular conditions.

Purpose of the Study:

• To evaluate the association between digoxin use and cardiovascular (CV) morbidity and mortality in patients with permanent atrial fibrillation.
• To assess digoxin's effectiveness in achieving heart rate control targets within the Dutch Rate Control Efficacy in Permanent AF trial.

Main Methods:

• The study analyzed data from 614 patients in the Dutch Rate Control Efficacy in Permanent AF trial.
• The primary outcome was a composite of CV morbidity and mortality, with secondary outcomes including CV hospitalization and all-cause mortality or heart failure hospitalization.
• Cox proportional hazards regression analysis was used to assess outcomes over a median follow-up of 2.9 years.

Main Results:

• Of 614 patients, 284 (46.7%) used digoxin post-dose adjustment.
• Digoxin use was not associated with an increased risk for primary (CV morbidity/mortality) or secondary outcomes.
• Estimated 3-year cumulative incidence for the primary outcome was similar between digoxin and no-digoxin groups (12.9% vs. 13.4%).

Conclusions:

• The findings indicate that digoxin use is not associated with increased cardiovascular morbidity and mortality in patients with permanent atrial fibrillation.
• This contrasts with some previous findings and suggests a potentially safer role for digoxin in specific patient populations.