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Digoxin and risk of death in adults with atrial fibrillation: the ATRIA-CVRN study

James V Freeman1, Kristi Reynolds1, Margaret Fang1

  • 1From the Department of Medicine, Yale University School of Medicine, New Haven, CT (J.V.F.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R., T.N.H.); Departments of Medicine (M.F., A.S.G.) and Epidemiology and Biostatistics (A.S.G.), University of California, San Francisco; Division of Research, Kaiser Permanente Northern California, Oakland (N.U., N.K.P., A.S.G); Division of Cardiology, Kaiser Permanente Santa Clara Medical Center, CA (A.S.); Clinical Epidemiology Unit, Massachusetts General Hospital, Boston (L.H.B., D.E.S.); Harvard Medical School, Boston, MA (D.E.S.); and Department of Health Research and Policy, Stanford University School of Medicine, CA (A.S.G.).

Circulation. Arrhythmia and Electrophysiology
|November 22, 2014
PubMed

Insights

Digoxin use in atrial fibrillation patients without heart failure was linked to increased risks of death and hospitalization. Caution is advised when considering digoxin for rate control due to these adverse outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • Digoxin is frequently used for rate control in atrial fibrillation.
  • Limited data support its efficacy, and some studies suggest adverse outcomes.
  • The association between digoxin and risks in patients without heart failure is not well-established.

Purpose of the Study:

  • To examine the independent association between digoxin initiation and risks of death and hospitalization.
  • To evaluate digoxin's safety profile in adults with incident atrial fibrillation and no prior heart failure.

Main Methods:

  • Retrospective cohort study of 14,787 adults with incident atrial fibrillation and no heart failure.
  • High-dimensional propensity score matching was used to control for confounders.
  • Extended Cox regression analyzed the association between digoxin use and adverse outcomes.

Main Results:

  • Incident digoxin use was associated with higher rates of death (8.3 vs. 4.9 per 100 person-years) and hospitalization (60.1 vs. 37.2 per 100 person-years).
  • Digoxin use independently increased the risk of death by 71% (HR, 1.71) and hospitalization by 63% (HR, 1.63).
  • Findings were consistent across subgroups and analytic approaches.

Conclusions:

  • Digoxin use in adults with atrial fibrillation is independently associated with increased risks of death and hospitalization.
  • Given alternative rate control options, digoxin should be used cautiously in atrial fibrillation management.
Abstract

Keywords:
arrhythmiaatrial fibrillationdigoxinmorbiditymortality

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