The present systematic review and meta- analysis of all available data sources suggest that digoxin use is associated with an increased mortality risk , particularly among patients suffering from AF
There are conflicting data regarding the effect of digoxin use on mortality in patients with atrial fibrillation ( AF ) or with congestive heart failure ( CHF ) .
The aim of this meta- analysis was to provide detailed analysis of the currently available study reports .
Effects of Digoxin on Morbidity and Mortality in Diastolic Heart Failure: The Ancillary Digitalis Investigation Group Trial
Background — About half of the 5 million heart failure patients in the United States have diastolic heart failure ( clinical heart failure with normal or near-normal ejection fraction ) . Except for c and esartan , no drugs have been tested in r and omized clinical trials in these patients . Although digoxin was tested in an appreciable number of diastolic heart failure patients in the Digitalis Investigation Group ancillary trial , detailed findings from this important study have not previously been published . Methods and Results — Ambulatory chronic heart failure patients ( n=988 ) with normal sinus rhythm and ejection fraction > 45 % ( median , 53 % ) from the United States and Canada ( 1991 to 1993 ) were r and omly assigned to digoxin ( n=492 ) or placebo ( n=496 ) . During follow-up with a mean length of 37 months , 102 patients ( 21 % ) in the digoxin group and 119 patients ( 24 % ) in the placebo group ( hazard ratio [ HR ] , 0.82 ; 95 % confidence interval [ CI ] , 0.63 to 1.07 ; P=0.136 ) experienced the primary combined outcome of heart failure hospitalization or heart failure mortality .  Digoxin had no effect on all-cause or cause-specific mortality or on all-cause or cardiovascular hospitalization . Use of digoxin was associated with a trend toward a reduction in hospitalizations result ing from worsening heart failure ( HR , 0.79 ; 95 % CI , 0.59 to 1.04 ; P=0.094 ) but also a trend toward an increase in hospitalizations for unstable angina ( HR , 1.37 ; 95 % CI , 0.99 to 1.91 ; P=0.061 ) . Conclusions — In ambulatory patients with chronic mild to moderate diastolic heart failure and normal sinus rhythm receiving angiotensin-converting enzyme inhibitor and diuretics , digoxin had no effect on natural history end points such as mortality and all-cause or cardiovascular hospitalizations
The present systematic review and meta- analysis of all available data sources suggest that digoxin use is associated with an increased mortality risk , particularly among patients suffering from AF
There are conflicting data regarding the effect of digoxin use on mortality in patients with atrial fibrillation ( AF ) or with congestive heart failure ( CHF ) .
The aim of this meta- analysis was to provide detailed analysis of the currently available study reports .