Cited by 208Atrial Fibrillation Management and OutcomesHeart Failure Treatment and ManagementPharmaceutical Practices and Patient Outcomes

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Increased Mortality Associated With Digoxin in Contemporary Patients With Atrial Fibrillation

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Turakhia, Mintu P., Santangeli, Pasquale, Winkelmayer, Wolfgang C., Xu, Xiangyan, Ullal, Aditya J., Than, Claire T., Schmitt, Susan, Holmes, Tyson H., Frayne, Susan M., Phibbs, Ciaran S., Yang, Felix, Hoang, Donald D., Ho, P. Michael, Heidenreich, Paul A.·2014·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2014.03.060PMC PMC4405246

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Abstract

Background Despite endorsement of digoxin in clinical practice guidelines, there exist limited data on its safety in atrial fibrillation/flutter (AF).Objectives The goal of this study was to evaluate the association of digoxin with mortality in AF.Methods Using complete data of the TREAT-AF (The Retrospective Evaluation and Assessment of Therapies in AF) study from the U.S. Department of Veterans Affairs (VA) healthcare system, we identified patients with newly diagnosed, nonvalvular AF seen within 90 days in an outpatient setting between VA fiscal years 2004 and 2008. We used multivariate and propensity-matched Cox proportional hazards to evaluate the association of digoxin use with death. Residual confounding was assessed by sensitivity analysis.Results Of 122,465 patients with 353,168 person-years of follow-up (age 72.1 ± 10.3 years, 98.4% male), 28,679 (23.4%) patients received digoxin. Cumulative mortality rates were higher for digoxin-treated patients than for untreated patients (95 vs. 67 per 1,000 person-years; p < 0.001). Digoxin use was independently associated with mortality after multivariate adjustment (hazard ratio [HR]: 1.26, 95% confidence interval [CI]: 1.23 to 1.29, p < 0.001) and propensity matching (HR: 1.21, 95% CI: 1.17 to 1.25, p < 0.001), even after adjustment for drug adherence. The risk of death was not modified by age, sex, heart failure, kidney function, or concomitant use of beta-blockers, amiodarone, or warfarin.Conclusions Digoxin was associated with increased risk of death in patients with newly diagnosed AF, independent of drug adherence, kidney function, cardiovascular comorbidities, and concomitant therapies. These findings challenge current cardiovascular society recommendations on use of digoxin in AF.

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Authors: Turakhia, M. P., Santangeli, P., Winkelmayer, W. C., Xu, X., Ullal, A. J., Than, C. T., Schmitt, S., Holmes, T. H., Frayne, S. M., Phibbs, C. S., Yang, F., Hoang, D. D., Ho, P. M., & Heidenreich, P. A.
Affiliations: VA Palo Alto Health Care System (US)
Stanford Medicine (US)
Maimonides Medical Center (US)
VA Eastern Colorado Health Care System (US)
Corresponding author: Turakhia, Mintu P.
ORCID: Turakhia, Mintu P.
Santangeli, Pasquale
Than, Claire T.
Holmes, Tyson H.
Frayne, Susan M.
Phibbs, Ciaran S.
Yang, Felix
Ho, P. Michael
Heidenreich, Paul A.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2014-08
Volume: 64
Issue: 7
Pages: 660-668
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2014.03.060
PMC: PMC4405246
OpenAlex: W2157998686
Cited by: 208
References: 31
Citations by year: 2026: 4 · 2025: 6 · 2024: 4 · 2023: 9 · 2022: 12 · 2021: 18 · 2020: 17 · 2019: 19 · 2018: 11 · 2017: 21 · 2016: 37 · 2015: 41 · 2014: 9
FWCI: 24.69
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 383 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: American Heart Association (09SDG2250647, CDA09027-1)
Amgen
GlaxoSmithKline
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK095024)
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 › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords: digoxin, atrial fibrillation, mortality, drug safety, newly diagnosed atrial fibrillation, non-valvular atrial fibrillation, medication adherence, veterans, propensity score matching, beta-blockers, amiodarone, warfarin
MeSH terms: Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Cause of Death, Digoxin, Female, Follow-Up Studies, Humans, Male, Outpatients, Prognosis, Retrospective Studies, Risk Factors, United States, Survival Rate, Confidence Intervals, Proportional Hazards Models, Risk Assessment, Propensity Score

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Increased Mortality Associated With Digoxin in Contemporary Patients With Atrial Fibrillation

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