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Digoxin Use and Adverse Outcomes in Patients With Atrial Fibrillation

View Article: PubMed Central - PubMed

ABSTRACT

Digoxin has long been used for rate control in atrial fibrillation (AF); its safety remains controversial.

We performed a literature search using MEDLINE (source PubMed, January 1, 1966, to July 31, 2015) and EMBASE (January 1, 1980, to July 31, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Pooled effect estimates were obtained by using random-effects meta-analysis.

Twenty-two studies involving 586,594 patients were identified. Patients taking digoxin, as compared with those who took no digoxin, experienced an increased risk of death from any cause (RR: 1.29[95% CI 1.16–1.43]), even after reported adjustment for propensity scores (RR: 1.28[95% CI 1.18–1.39]). The risk of death was increased with patients with or without heart failure (RR: 1.12[95% CI 1.02–1.23] and RR: 1.26[95% CI 1.15–1.29], respectively), and patients taking or not taking beta blockers (RR: 1.17 [95% CI 1.06–1.30] and RR: 1.28 [95% CI 1.08–1.51], respectively). Digoxin use was also associated with increased risk of cardiovascular death (RR: 1.32 [95% CI 1.07–1.64]), arrhythmic death (RR: 1.38 [95% CI 1.07–1.79]), and stroke (RR: 1.20 [95% CI 1.004–1.44]). Digoxin treatment is associated with an absolute risk increase of 19 (95% CI 13–26) additional deaths from any cause per 1000 person-years.

Digoxin use is associated with a significant increased risk for death from any cause in patients with AF. This finding suggests a need for reconsideration of present treatment recommendations on use of digoxin in AF.

No MeSH data available.


Related in: MedlinePlus

Forest plot showing relative risks of death from any cause associated with digoxin therapy in patients with atrial fibrillation. The size of each square is proportional to the study's weight (inverse of variance).
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Figure 1: Forest plot showing relative risks of death from any cause associated with digoxin therapy in patients with atrial fibrillation. The size of each square is proportional to the study's weight (inverse of variance).

Mentions: Twenty-one studies with data of 573,114 individuals and at least 225,453 events reported risk estimates for death from any cause. Among the 21 selected studies, all but 2 found an association between use of digoxin and an increased risk of death from any cause, although not all were statistically significant. Overall, patients with AF taking digoxin compared with the reference group experienced a significantly increased risk for death from any cause (RR: 1.29 [95% CI 1.16–1.43, P<0.001]) (Figure 1). From studies that reported information on person-years in patients taking and not taking digoxin, we could calculate absolute annual rates of death from patients with AF: 73 deaths per 1000 person-years in patients taking digoxin and 54 deaths in patients not taking digoxin, corresponding to an absolute risk increase of 19 (95% CI 13–26) deaths per 1000 person-years.


Digoxin Use and Adverse Outcomes in Patients With Atrial Fibrillation
Forest plot showing relative risks of death from any cause associated with digoxin therapy in patients with atrial fibrillation. The size of each square is proportional to the study's weight (inverse of variance).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998364&req=5

Figure 1: Forest plot showing relative risks of death from any cause associated with digoxin therapy in patients with atrial fibrillation. The size of each square is proportional to the study's weight (inverse of variance).
Mentions: Twenty-one studies with data of 573,114 individuals and at least 225,453 events reported risk estimates for death from any cause. Among the 21 selected studies, all but 2 found an association between use of digoxin and an increased risk of death from any cause, although not all were statistically significant. Overall, patients with AF taking digoxin compared with the reference group experienced a significantly increased risk for death from any cause (RR: 1.29 [95% CI 1.16–1.43, P<0.001]) (Figure 1). From studies that reported information on person-years in patients taking and not taking digoxin, we could calculate absolute annual rates of death from patients with AF: 73 deaths per 1000 person-years in patients taking digoxin and 54 deaths in patients not taking digoxin, corresponding to an absolute risk increase of 19 (95% CI 13–26) deaths per 1000 person-years.

View Article: PubMed Central - PubMed

ABSTRACT

Digoxin has long been used for rate control in atrial fibrillation (AF); its safety remains controversial.

We performed a literature search using MEDLINE (source PubMed, January 1, 1966, to July 31, 2015) and EMBASE (January 1, 1980, to July 31, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Pooled effect estimates were obtained by using random-effects meta-analysis.

Twenty-two studies involving 586,594 patients were identified. Patients taking digoxin, as compared with those who took no digoxin, experienced an increased risk of death from any cause (RR: 1.29[95% CI 1.16&ndash;1.43]), even after reported adjustment for propensity scores (RR: 1.28[95% CI 1.18&ndash;1.39]). The risk of death was increased with patients with or without heart failure (RR: 1.12[95% CI 1.02&ndash;1.23] and RR: 1.26[95% CI 1.15&ndash;1.29], respectively), and patients taking or not taking beta blockers (RR: 1.17 [95% CI 1.06&ndash;1.30] and RR: 1.28 [95% CI 1.08&ndash;1.51], respectively). Digoxin use was also associated with increased risk of cardiovascular death (RR: 1.32 [95% CI 1.07&ndash;1.64]), arrhythmic death (RR: 1.38 [95% CI 1.07&ndash;1.79]), and stroke (RR: 1.20 [95% CI 1.004&ndash;1.44]). Digoxin treatment is associated with an absolute risk increase of 19 (95% CI 13&ndash;26) additional deaths from any cause per 1000 person-years.

Digoxin use is associated with a significant increased risk for death from any cause in patients with AF. This finding suggests a need for reconsideration of present treatment recommendations on use of digoxin in AF.

No MeSH data available.


Related in: MedlinePlus