Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Digoxin is prescribed for rate control in atrial fibrillation (AF).
• Evidence on digoxin's efficacy and safety post-myocardial infarction (MI) is limited and conflicting.
• Digoxin use in AF patients following MI requires further investigation.

Purpose of the Study:

• To evaluate the association between digoxin use and patient outcomes after MI in individuals with AF.
• To assess the impact of digoxin on all-cause mortality, heart failure (HF) hospitalizations, stroke, and new MI.
• To identify specific patient subgroups that may be at higher risk.

Main Methods:

• A nationwide registry follow-up study in Finland (2004-2014).
• Included 881 digoxin users and 3,898 controls, with baseline differences balanced using inverse probability of treatment weighting.
• Median follow-up duration of 7.4 years, with a 10-year follow-up for mortality.

Main Results:

• Digoxin use post-MI was associated with higher cumulative all-cause mortality (HR: 1.19; p=0.001).
• Increased mortality was observed in patients without baseline heart failure (HF) (HR: 1.23; p=0.019), but not in those with HF (HR: 1.05; p=0.413).
• No significant differences in HF hospitalizations, stroke, or new MI were found between groups.

Conclusions:

• Digoxin use after MI in AF patients is linked to increased all-cause mortality.
• The increased mortality risk is particularly evident in patients without baseline heart failure.
• These findings suggest a need for caution when prescribing digoxin post-MI for AF patients, especially if HF is absent.