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Increased All-Cause Mortality Associated With Digoxin Therapy in Patients With Atrial Fibrillation: An Updated

Ying Chen1, Xiaoyan Cai, Weijun Huang

  • 1From the Department of Cardiology (YC, WH, YW, YH, YH); The Second Out-patient Department, the First People's Hospital of Shunde (YC); and Clinical Medicine Research Institute, the First People's Hospital of Shunde, Foshan, P.R. China (XC, YH, YH).

Medicine
|December 31, 2015
PubMed

Insights

Digoxin use in atrial fibrillation (AF) increases mortality risk, particularly in patients without heart failure (HF). This meta-analysis suggests avoiding digoxin as a first-line treatment for heart rate control in AF.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • Digoxin is frequently prescribed for heart rate control in atrial fibrillation (AF), with or without heart failure (HF).
  • Existing research on digoxin's adverse effects in AF patients presents conflicting findings.
  • This study addresses the need for updated evidence on digoxin's association with mortality in AF.

Purpose of the Study:

  • To conduct a meta-analysis investigating the association between digoxin therapy and all-cause mortality in atrial fibrillation (AF) patients.
  • To stratify the analysis based on heart function status (presence or absence of heart failure).
  • To provide evidence-based recommendations for digoxin use in AF management.

Main Methods:

  • Systematic review and meta-analysis of observational studies.
  • Inclusion of studies with multivariate-adjusted data on digoxin and all-cause mortality.
  • Calculation and reporting of relative risks (RRs) with 95% confidence intervals (CIs).

Main Results:

  • Seventeen studies involving 408,660 patients were analyzed.
  • Overall, digoxin use in AF patients was linked to a significant increase in all-cause mortality (RR=1.22; 95% CI 1.15-1.30).
  • The mortality risk was higher in AF patients without HF (RR=1.36; 95% CI 1.18-1.56) compared to those with HF (RR=1.14; 95% CI 1.04-1.24).

Conclusions:

  • Digoxin therapy is associated with increased all-cause mortality in atrial fibrillation patients.
  • The elevated mortality risk is significantly more pronounced in AF patients without heart failure.
  • Digoxin should be reconsidered as a first-line agent for heart rate control in AF, given safer alternatives.

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