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 .
Sex-based differences in the effect of digoxin for the treatment of heart failure.
BACKGROUND The Digitalis Investigation Group trial reported that treatment with digoxin did not decrease overall mortality among patients with heart failure and depressed left ventricular systolic function , although it did reduce hospitalizations slightly . Even though the epidemiologic features , causes , and prognosis of heart failure vary between men and women , sex-based differences in the effect of digoxin were not evaluated . METHODS We conducted a post hoc subgroup analysis to assess whether there were sex-based differences in the effect of digoxin therapy among the 6800 patients in the Digitalis Investigation Group study . The presence of an interaction between sex and digoxin therapy with respect to the primary end point of death from any cause was evaluated with the use of Mantel-Haenszel tests of heterogeneity and a multivariable Cox proportional-hazards model , adjusted for demographic and clinical variables . RESULTS There was an absolute difference of 5.8 percent ( 95 percent confidence interval , 0.5 to 11.1 ) between men and women in the effect of digoxin on the rate of death from any cause ( P=0.034 for the interaction ) . Specifically , women who were r and omly assigned to digoxin had a higher rate of death than women who were r and omly assigned to placebo ( 33.1 percent vs. 28.9 percent ; absolute difference , 4.2 percent , 95 percent confidence interval , -0.5 to 8.8 ) . In contrast , the rate of death was similar among men r and omly assigned to digoxin and men r and omly assigned to placebo ( 35.2 percent vs. 36.9 percent ; absolute difference , -1.6 percent ; 95 percent confidence interval , -4.2 to 1.0 ) . In the multivariable analysis , digoxin was associated with a significantly higher risk of death among women ( adjusted hazard ratio for the comparison with placebo , 1.23 ; 95 percent confidence interval , 1.02 to 1.47 ) , but it had no significant effect among men ( adjusted hazard ratio , 0.93 ; 95 percent confidence interval , 0.85 to 1.02 ; P=0.014 for the interaction ) . CONCLUSIONS The effect of digoxin therapy differs between men and women .  Digoxin therapy is associated with an increased risk of death from any cause among women , but not men , with heart failure and depressed left ventricular systolic function
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 .