Related Experiment Video
Updated: Apr 23, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Does digoxin increase the risk of ischemic stroke and mortality in atrial fibrillation? A nationwide population-based
Tze-Fan Chao1, Chia-Jen Liu2, Su-Jung Chen3
1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
Insights
Digoxin use in atrial fibrillation (AF) patients without heart failure increases stroke and mortality risk. Beta-blockers may be a safer alternative for rate control in this population.
Area of Science:
- Cardiology
- Pharmacology
- Epidemiology
Background:
- Digoxin has been a long-standing treatment for atrial fibrillation (AF).
- Previous analyses of the AFFIRM trial yielded conflicting data on digoxin's mortality risk.
- This study addresses the need for clarity on digoxin's risks in Asian populations.
Purpose of the Study:
- To investigate the association between digoxin use and the risk of ischemic stroke and mortality in Asian patients with AF.
- To explore potential modifying effects of heart failure on this association.
- To compare the efficacy of beta-blockers versus digoxin in specific AF patient subgroups.
Main Methods:
- Utilized Taiwan's National Health Insurance Research Database (NHIRD).
- Included 4781 AF patients without antithrombotic therapy.
- Compared outcomes between 829 digoxin users and non-users.
Main Results:
- Digoxin use was linked to a higher risk of ischemic stroke (HR 1.41) and all-cause mortality (HR 1.21).
- Digoxin increased risks in AF patients without heart failure, but not those with heart failure (interaction P < 0.001).
- Beta-blockers improved survival in AF patients without heart failure (HR 0.48).
Conclusions:
- Digoxin should be avoided in AF patients who do not have heart failure due to increased clinical event risks.
- Beta-blockers represent a potentially safer option for ventricular rate control in this patient group.
- Further research may refine treatment strategies for AF based on comorbidities.
Background:
Digoxin and related cardiac glycosides have been used for almost 100 years in atrial fibrillation (AF). However, 2 recent analyses of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial showed inconsistent results regarding the risk of mortality associated with digoxin use. The goal of the present study was to investigate the relationship between digoxin and the risk of ischemic stroke and mortality in Asians.
Methods:
This study used the National Health Insurance Research Database (NHIRD) in Taiwan. A total of 4781 patients with AF who did not receive any antithrombotic therapy were selected as the study population. Among the study population, 829 participants (17.3%) received the digoxin treatment. The risk of ischemic stroke and mortality in patients who received digoxin and those who did not was compared.
Results:
The use of digoxin was associated with an increased risk of clinical events, with an adjusted hazard ratio of 1.41 (95% confidence interval [CI], 1.17-1.70) for ischemic stroke and 1.21 (95% CI, 1.01-1.44) for all-cause mortality. In the subgroup analysis based on coexistence with heart failure or not, digoxin was a risk factor for adverse events in patients without heart failure but not in those with heart failure (interaction P < 0.001 for either end point). Among patients with AF without heart failure, the use of β-blockers was associated with better survival, with an adjusted hazard ratio of 0.48 (95% CI, 0.34-0.68).
Conclusions:
Digoxin should be avoided for patients with AF without heart failure because it was associated with an increased risk of clinical events. β-Blockers may be a better choice for controlling ventricular rate in these patients.
