Related Experiment Video
Updated: Oct 16, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Outcomes of digoxin vs. beta blocker in atrial fibrillation: report from ESC-EHRA EORP AF Long-Term General Registry
Wern Yew Ding1, Giuseppe Boriani2, Francisco Marin3
1Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Insights
Digoxin use in atrial fibrillation (AF) patients was linked to higher mortality and lower quality of life compared to beta-blockers. However, these poor outcomes were associated with other risk factors, not digoxin itself.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- The safety and efficacy of digoxin in managing atrial fibrillation (AF) are not well-established.
- Beta-blockers are a common alternative treatment for AF.
Purpose of the Study:
- To compare the safety and effectiveness of digoxin versus beta-blocker therapy in patients with atrial fibrillation.
- To evaluate the impact of digoxin on mortality, quality of life, and hospitalizations in AF patients.
Main Methods:
- Analysis of data from the European Society of Cardiology-European Heart Rhythm Association EURObservational Research Programme Atrial Fibrillation General Long-Term Registry.
- Inclusion of 6377 patients with AF, comparing outcomes between those treated with digoxin (549 patients) and beta-blockers.
- Assessment of all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, quality of life, and unplanned hospitalizations over 24 months.
Main Results:
- Digoxin therapy was initially associated with increased all-cause, cardiovascular, and non-cardiovascular mortality, and reduced quality of life compared to beta-blockers.
- No significant differences in emergency or AF-related hospitalizations were observed between the two groups.
- After multivariable analysis adjusting for confounders, no significant differences in outcomes were found between digoxin and beta-blocker groups, including in subgroups with permanent AF, heart failure, or chronic kidney disease.
Conclusions:
- The observed poorer outcomes with digoxin in AF patients appear to be linked to underlying risk factors rather than digoxin treatment itself.
- Digoxin or beta-blocker choice did not influence unplanned hospitalization rates.
- Further research is needed to clarify the role of digoxin in specific AF patient populations.
Aims:
The safety of digoxin therapy in atrial fibrillation (AF) remains ill-defined. We aimed to evaluate the effects of digoxin over beta-blocker therapy in AF.
Methods And Results:
Patients with AF who were treated with either digoxin or a beta blocker from the ESC-EHRA EORP AF (European Society of Cardiology-European Heart Rhythm Association EURObservational Research Programme Atrial Fibrillation) General Long-Term Registry were included. Outcomes of interest were all-cause mortality, cardiovascular (CV) mortality, non-CV mortality, quality of life, and number of patients with unplanned hospitalizations. Of 6377 patients, 549 (8.6%) were treated with digoxin. Over 24 months, there were 550 (8.6%) all-cause mortality events and 1304 (23.6%) patients with unplanned emergency hospitalizations. Compared to beta blocker, digoxin therapy was associated with increased all-cause mortality [hazard ratio (HR) 1.90 (95% confidence interval, CI, 1.48-2.44)], CV mortality [HR 2.18 (95% CI 1.47-3.21)], and non-CV mortality [HR 1.68 (95% CI 1.02-2.75)] with reduced quality of life [health utility score 0.555 (±0.406) vs. 0.705 (±0.346), P < 0.001] but no differences in emergency hospitalizations [HR 1.00 (95% CI 0.56-1.80)] or AF-related hospitalizations [HR 0.95 (95% CI 0.60-1.52)]. On multivariable analysis, there were no differences in any of the outcomes between both groups, after accounting for potential confounders. Similar results were obtained in the subgroups of patients with permanent AF and coexisting heart failure. There were no differences in outcomes between AF patients receiving digoxin with and without chronic kidney disease.
Conclusion:
Poor outcomes related to the use of digoxin over beta-blocker therapy in terms of excess mortality and reduced quality of life are associated with the presence of other risk factors rather than digoxin per se. The choice of digoxin or beta-blocker therapy had no influence on the incidence of unplanned hospitalizations.
Related Concept Videos
01:22Heart Failure Drugs: β-Blockers
01:26Heart Failure Drugs: Inotropic Agents
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
01:12Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers