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Published on: February 26, 2013
Systematic review and meta-analysis of mortality and digoxin use in atrial fibrillation
Waqas Qureshi1, Wesley T O'Neal, Elsayed Z Soliman
1Department of Internal Medicine, Division of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States. wqureshi@wakehealth.edu.
Insights
Digoxin use in atrial fibrillation (AF) patients is linked to a higher risk of death. This risk is notably greater in AF patients without heart failure, warranting further investigation.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Growing controversy surrounds digoxin's association with mortality in atrial fibrillation (AF).
- Systematic review needed to clarify digoxin use and mortality risk in AF patients.
Purpose of the Study:
- To systematically review and analyze the risk of mortality associated with digoxin use in patients diagnosed with atrial fibrillation (AF).
Main Methods:
- Comprehensive literature search across multiple databases (MEDLINE, EMBASE, etc.) up to December 2014.
- Inclusion criteria focused on studies reporting mortality risk as an outcome for digoxin use in AF patients.
- Data extraction by two independent authors; evidence tables compiled.
Main Results:
- Analysis of 16 studies involving 111,978 digoxin users and 389,643 non-users.
- Digoxin use correlated with a 27% increased risk of all-cause mortality (HR 1.27) and 21% for cardiovascular mortality (HR 1.21).
- The association between digoxin and mortality was stronger in AF patients without heart failure (HR 1.47) compared to those with heart failure (HR 1.21).
Conclusions:
- Digoxin use in AF patients is associated with increased all-cause and cardiovascular mortality.
- The increased mortality risk from digoxin is more pronounced in AF patients without heart failure.
- Further research is recommended to investigate this effect, particularly in the AF without heart failure subgroup.
Background:
There is growing controversy regarding the association between digoxin and mortality in atrial fibrillation (AF). The aim of this analysis was to systematically review digoxin use and risk of mortality in patients with AF.
Methods:
MEDLINE, EMBASE, GoogleScholar, CINAHL, meeting abstracts, presentations, and Cochrane central databases were searched from inception through December 2014, without language restrictions. For a study to be selected, it had to report the risk of mortality associated with digoxin use in AF patients as an outcome measure. Data were extracted by 2 independent authors. Evidence tables were created.
Results:
A total of 16 studies (6 post hoc analyses of randomized controlled trials) with 111,978 digoxin users and 389,643 non-digoxin users were included. In a random effects model, patients treated with digoxin had a 27% increased risk of all-cause mortality (pooled HR 1.27; 95% CI 1.19-1.36) and 21% increased risk of cardiovascular mortality (pooled HR 1.21; 95% CI 1.12-1.30) compared with those who did not use digoxin. In a random effects model, the association of digoxin with all-cause mortality was stronger for AF patients without heart failure (pooled HR 1.47; 95% CI 1.25-1.73) than AF patients with heart failure (pooled HR 1.21; 95% CI 1.07-1.36, interaction p = 0.06).
Conclusions:
Digoxin use in AF is associated with increased risk of all-cause and cardiovascular mortalities. The effect size was larger for AF patients without heart failure than AF patients with heart failure. The study suggests further directed analyses to study the effect that is suggested by this meta-analysis, especially in AF without heart failure.
