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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Digoxin and Mortality in Patients With Atrial Fibrillation

Renato D Lopes1, Roberto Rordorf2, Gaetano M De Ferrari2

  • 1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.

Journal of the American College of Cardiology
|March 10, 2018
PubMed

Insights

Digoxin use in atrial fibrillation (AF) patients is linked to increased mortality, especially with higher serum concentrations (≥1.2 ng/ml). Starting digoxin also independently raises death risk, irrespective of heart failure status.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • Digoxin is a common medication for managing atrial fibrillation (AF).
  • Understanding the risks associated with digoxin use in AF patients is crucial for clinical decision-making.

Purpose of the Study:

  • To determine if digoxin use is independently associated with increased mortality in atrial fibrillation (AF) patients.
  • To investigate if heart failure or serum digoxin concentration modifies this association.

Main Methods:

  • Propensity score-adjusted analysis of 17,897 patients to assess digoxin use and mortality.
  • Analysis of new digoxin users versus matched controls.
  • Multivariable adjustment to examine serum digoxin concentration and mortality.

Main Results:

  • Baseline digoxin use was not linked to increased mortality (aHR: 1.09).
  • Serum digoxin concentration ≥1.2 ng/ml was associated with a 56% increased mortality hazard (aHR: 1.56).
  • Each 0.5-ng/ml increase in serum digoxin concentration correlated with a 19% higher mortality hazard (p=0.0010).
  • New digoxin users showed significantly higher risks of death and sudden death.

Conclusions:

  • In AF patients, digoxin use poses an independent mortality risk related to serum concentration, with highest risk at ≥1.2 ng/ml.
  • Initiating digoxin is independently associated with increased mortality in AF patients, independent of heart failure.
Abstract

Keywords:
atrial fibrillationdigoxinheart failuremortality

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