Atrial Fibrillation Mortality May Increase With Digoxin

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Digoxin was independently associated with higher mortality in patients with afib regardless of whether they had heart failure.
Digoxin was independently associated with higher mortality in patients with afib regardless of whether they had heart failure.

HealthDay News — Digoxin was independently associated with higher mortality in patients with atrial fibrillation (AF) regardless of whether they had heart failure, according to a study published in the Journal of the American College of Cardiology.

Renato D. Lopes, MD, PhD, from the Duke University School of Medicine in Durham, North Carolina, and colleagues examined whether digoxin use was independently associated with increased mortality in 17,897 patients with AF and whether the association was modified by heart failure and/or serum digoxin concentration.

The researchers found that at baseline, just under one-third of patients (5824) were receiving digoxin. 

There was no increased risk for death associated with baseline digoxin use (adjusted hazard ratio [HR], 1.09; 95% CI, 0.96-1.23; P =.19). However, compared with patients not on digoxin, patients with a serum digoxin concentration ≥1.2 ng/mL had a 56% increased hazard of mortality (adjusted HR, 1.56; 95% CI, 1.2-2.04). For each 0.5-ng/mL increase (P =.001), there was a 19% higher adjusted hazard for death, and these results were similar in patients with and without heart failure. Compared with propensity score-matched controls, new digoxin users had a significantly increased risk for death (adjusted HR, 1.78; 95% CI, 1.37-2.31) and sudden death (adjusted HR, 2.14; 95% CI, 1.11-4.12.)

"Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure," the authors wrote.

Disclosures: Several authors disclosed financial ties to medical device and pharmaceutical companies, including Bristol-Myers Squibb and Pfizer, which funded the study.

Reference

Lopes RD, Rordorf R, De Ferrari GM, et al. Digoxin and mortality in patients with atrial fibrillation. J Am Coll Cardiol. 2018;71(10):1063-1074.

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