Discussion The results of this systematic review have the potential to benefit thous and s of patients worldwide as well as healthcare systems and healthcare economy .
Background Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2 % in the western world .
Atrial flutter , another arrhythmia , occurs less often with an incidence of approximately 200,000 new patients per year in the USA .
Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities .
The management of atrial fibrillation and atrial flutter is often based on interventions aim ing at either a rhythm control strategy or a rate control strategy .
The evidence on the comparable effects of these strategies is unclear .
This protocol for a systematic review aims at identifying the best overall treatment strategy for atrial fibrillation and atrial flutter .
Digoxin use and risk of mortality in hypertensive patients with atrial fibrillation
Background : Digoxin is widely used for rate control of atrial fibrillation . However , recent studies have reported conflicting results on the association of digoxin with mortality when used in patients with atrial fibrillation . Moreover , the relationship of digoxin use to mortality in hypertensive patients with atrial fibrillation has not been examined . Methods and results : All-cause mortality was examined in relation to in-treatment digoxin use in 937 hypertensive patients with ECG left ventricular hypertrophy in atrial fibrillation at baseline ( n = 134 ) or who developed atrial fibrillation during follow-up ( n = 803 ) , r and omly assigned to losartan or atenolol-based treatment , in post-hoc analysis of a sub study of the Losartan  Intervention For Endpoint Reduction in hypertension ( LIFE ) trial . During 4.7 ± 1.1 years of mean follow-up , 167 patients died ( 17.8 % ) and 372 ( 39.7 % ) were treated with digoxin . In univariate Cox analyses , in-treatment digoxin use , entered as a time-varying covariate , was associated with a 61 % higher risk of dying ( hazard ratio 1.61 , 95 % confidence interval 1.18–2.19 , P = 0.003 ) . After adjusting for other univariate predictors of death in this population , including age , diabetes , history of ischemic heart disease , stroke , or heart failure , baseline Cornell product , QRS duration , heart rate , serum glucose , creatinine and high-density lipoprotein cholesterol , and a propensity score for digoxin use entered as st and ard covariates , and for in-treatment heart rate , pulse pressure , and Sokolow – Lyon voltage treated as time-varying covariates , digoxin use was no longer a significant predictor of mortality ( hazard ratio 1.04 , 95 % confidence interval 0.73–1.48 , P = 0.839 ) . Conclusion : In hypertensive patients with ECG left ventricular hypertrophy with existing or new atrial fibrillation , digoxin use is not associated with a significantly increased risk of all-cause mortality after adjusting for other independent predictors of death and for the factors associated with the propensity to use digoxin in this population . These findings suggest that factors other than digoxin use may account for the increased mortality found with digoxin use in some studies . Clinical Trials Registration : http:// clinical
Discussion The results of this systematic review have the potential to benefit thous and s of patients worldwide as well as healthcare systems and healthcare economy .
Background Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2 % in the western world .
Atrial flutter , another arrhythmia , occurs less often with an incidence of approximately 200,000 new patients per year in the USA .
Patients with atrial fibrillation and atrial flutter have an increased risk of death and morbidities .
The management of atrial fibrillation and atrial flutter is often based on interventions aim ing at either a rhythm control strategy or a rate control strategy .
The evidence on the comparable effects of these strategies is unclear .
This protocol for a systematic review aims at identifying the best overall treatment strategy for atrial fibrillation and atrial flutter .