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 .
Digoxin treatment is associated with increased total and cardiovascular mortality in anticoagulated patients with atrial fibrillation.
BACKGROUND Some evidence s suggest that the use of digoxin may be harmful inatrial fibrillation ( AF ) patients . The aim of the study was to investigate in a " real world " of AF patients receiving vitamin K antagonists ( VKAs )  , the relationship between digoxin use and mortality . METHODS Prospect i ve single-center observational study including 815 consecutive non-valvular AF patients treated with VKAs .  Total mortality was the primary outcome of the study . We also performed a sub- analysis considering only cardiovascular ( CV ) deaths . Time in therapeutic range ( TTR ) was used for anticoagulation quality . RESULTS Median follow-up was 33.2months ( 2460 person-years ) ; 171 ( 21.0 % ) patients were taking digoxin .  Compared to those without , patients on digoxin were older ( p=0.007 ) , with a clinical history of HF ( p<0.001 ) and at higher risk of thromboembolic events ( p<0.001 ) . No difference in TTR between the two groups was registered ( p=0.598 ) . During the follow-up , 85 deaths occurred : 47 CV and 38 non-CV deaths ; 35 deaths occurred in digoxin users ( 20.6 % ) . A significant increased rate of total mortality was observed in  digoxin-treated  patients ( p<0.001 ) . Multivariable analysis showed that digoxin was associated with total mortality ( hazard ratio [ HR ] : 2.224 , p<0.001 ) and CV death ( HR : 4.686 , p<0.001 ) . A propensity score-matched analysis confirmed that digoxin was associated with total mortality ( HR : 2.073 , p=0.0263 ) and CV death ( HR : 4.043 , p=0.004 ) . CONCLUSIONS In AF patients on good anticoagulation control with VKAs , digoxin use was associated with a higher rate of total and CV mortality
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 .