Digoxin and mortality in atrial fibrillation: a prospective cohort study
Abstract
Objective The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study showed that rhythm-control treatment of patients with atrial fibrillation (AF) offered no survival advantage over a rate-control strategy. In a subgroup analysis of that study, it was found that digoxin increased the death rate [relative risk (RR) = 1.42), but it was suggested that this may have been attributable to prescription of digoxin for patients at greater risk of death, such as those with congestive heart failure (CHF). No study has investigated a priori the effect of digoxin on mortality in patients with AF. This study aimed to address this question.Methods Using data from the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA), we studied the 1-year mortality among patients admitted to coronary care units with AF, CHF, or AF+CHF with or without digoxin (n = 60,764) during 1995-2003. Adjustment for differences in background characteristics and other medications and treatments was made by propensity scoring.Results Twenty percent of patients with AF without CHF in this cohort were discharged with digoxin. This group had a higher mortality rate than the corresponding group not given digoxin [adjusted RR 1.42 (95% CI 1.29-1.56)], whereas no such difference was seen among patients with CHF with or without AF, although these patients had a nearly three-times higher mortality.Conclusion The results suggest that long-term therapy with digoxin is an independent risk factor for death in patients with AF without CHF.
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Observational studies have associated digoxin use with excess mortality in AF patients.
“Observational studies have associated digoxin use with excess mortality in AF patients, [547][548][549] but this association is likely due to selection and prescription biases rather than harm caused by digoxin, [550][551][552][553] particularly as digoxin is commonly prescribed to sicker patients.225”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [548]
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- Authors
- Hallberg, P., Lindbäck, J., Lindahl, B., Stenestrand, U., Melhus, H., & for the RIKS-HIA group
- Affiliations
- Uppsala University (SE)
- Linköping University Hospital (SE)
- Corresponding author
- Hallberg, Pär
- Venue
- European Journal of Clinical Pharmacology
- Published
- 2007-08-08
- Volume
- 63
- Issue
- 10
- Pages
- 959-971
- ISSN
- 0031-6970 (ISSN-L)
- 1432-1041
- OpenAlex
- W1967375232
- Cited by
- 113
- References
- 44
- Citations by year
- 2025: 2 · 2024: 2 · 2022: 5 · 2021: 8 · 2020: 7 · 2019: 5 · 2018: 8 · 2017: 4 · 2016: 16 · 2015: 19 · 2014: 10 · 2013: 4 · 2012: 5
- FWCI
- 3.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Clinical Pharmacology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hjärt-Lungfonden
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- digoxin, atrial fibrillation, mortality, congestive heart failure, coronary care unit admission, rhythm control, rate control, cardiovascular risk factors
- MeSH terms
- Aged, Aged, 80 and over, Anti-Arrhythmia Agents, Atrial Fibrillation, Creatinine, Digoxin, Female, Heart Failure, Humans, Male, Myocardial Infarction, Prospective Studies, Registries, Research Design, Risk Factors, Stroke Volume, Sweden, Time Factors, Proportional Hazards Models, Ventricular Function, Left, Treatment Outcome, Risk Assessment
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