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Digoxin and Mortality in Patients With Atrial Fibrillation
Duke Univ, Sch Med, Duke Clin Res Inst, 2400 Pratt St, Durham, NC 27705 USA..
Fdn IRCCS Policlin San Matteo, Coronary Care Unit, Pavia, Italy.;Fdn IRCCS Policlin San Matteo, Lab Clin & Expt Cardiol, Pavia, Italy.;Univ Pavia, Dept Mol Med, Pavia, Italy..
Fdn IRCCS Policlin San Matteo, Coronary Care Unit, Pavia, Italy.;Fdn IRCCS Policlin San Matteo, Lab Clin & Expt Cardiol, Pavia, Italy.;Univ Pavia, Dept Mol Med, Pavia, Italy..
Fdn IRCCS Policlin San Matteo, Coronary Care Unit, Pavia, Italy.;Fdn IRCCS Policlin San Matteo, Lab Clin & Expt Cardiol, Pavia, Italy.;Univ Pavia, Dept Mol Med, Pavia, Italy..
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2018 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 71, no 10, p. 1063-1074Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Digoxin is widely used in patients with atrial fibrillation (AF). OBJECTIVES The goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with AF and if the association was modified by heart failure and/or serum digoxin concentration.

METHODS: The association between digoxin use and mortality was assessed in 17,897 patients by using a propensity score-adjusted analysis and in new digoxin users during the trial versus propensity score-matched control participants. The authors investigated the independent association between serum digoxin concentration and mortality after multivariable adjustment.

RESULTS: At baseline, 5,824 (32.5%) patients were receiving digoxin. Baseline digoxin use was not associated with an increased risk of death (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 0.96 to 1.23; p = 0.19). However, patients with a serum digoxin concentration $ 1.2 ng/ml had a 56% increased hazard of mortality (adjusted HR: 1.56; 95% CI: 1.20 to 2.04) compared with those not on digoxin. When analyzed as a continuous variable, serum digoxin concentration was associated with a 19% higher adjusted hazard of death for each 0.5-ng/ml increase (p = 0.0010); these results were similar for patients with and without heart failure. Compared with propensity score-matched control participants, the risk of death (adjusted HR: 1.78; 95% CI: 1.37 to 2.31) and sudden death (adjusted HR: 2.14; 95% CI: 1.11 to 4.12) was significantly higher in new digoxin users.

CONCLUSIONS: In patients with AF taking digoxin, the risk of death was independently related to serum digoxin concentration and was highest in patients with concentrations $ 1.2 ng/ml. Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2018. Vol. 71, no 10, p. 1063-1074
Keywords [en]
atrial fibrillation, digoxin, heart failure, mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-350280DOI: 10.1016/j.jacc.2017.12.060ISI: 000426569700001PubMedID: 29519345OAI: oai:DiVA.org:uu-350280DiVA, id: diva2:1204932
Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-05-09Bibliographically approved

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Ridefelt, PeterWallentin, Lars

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