Combination therapy of beta-blockers and digoxin is associated with increased risk of major adverse cardiovascular...

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Cardiovascular outcomes and mortality effects of digoxin and beta-blockers in atrial fibrillation (AF) patients are not fully understood.
• Atrial fibrillation management often involves rate-control medications like beta-blockers and digoxin.

Purpose of the Study:

• To compare cardiovascular (CV) outcomes and mortality rates in AF patients prescribed beta-blockers, digoxin, or combination therapy.
• To investigate the association between different medication regimens and adverse CV events and death.

Main Methods:

• Analysis of data from the prospective Global Registry on Long-Term Oral Anti-thrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF).
• Utilized Cox proportional hazard regression and propensity score (PS) matching/weighting to adjust for confounders.
• Included 14,201 AF patients with a median follow-up of 3.0 years.

Main Results:

• Combination therapy (beta-blockers + digoxin) was associated with a significantly higher risk of major adverse cardiovascular events (MACE) (HR 1.35) and all-cause death (HR 1.28) compared to beta-blockers alone.
• These findings remained significant after multivariate adjustment and PS analysis.
• Incidence rates were 22.4/1000 person-years for MACE and 25.4/1000 person-years for all-cause death.

Conclusions:

• In atrial fibrillation patients, combination therapy with beta-blockers and digoxin is linked to increased risks of MACE and all-cause mortality.
• Beta-blockers alone appear to be associated with better outcomes than combination therapy.
• These results suggest a need for careful consideration of combination therapy in AF management.