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 .
Lack of evidence of increased mortality among patients with atrial fibrillation taking digoxin: findings from post hoc propensity-matched analysis of the AFFIRM trial.
AIMS Digoxin is recommended for long-term rate control in paroxysmal , persistent , and permanent atrial fibrillation ( AF ) . While some analyses suggest an association of digoxin with a higher mortality in AF , the intrinsic nature of this association has not been examined in propensity-matched cohorts , which is the objective of the current study . METHODS AND RESULTS In Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) , 4060 patients with paroxysmal and persistent AF were r and omized to rate ( n = 2027 ) vs. rhythm ( n = 2033 ) control strategies . Of these , 1377 received digoxin as initial therapy and 1329 received no digoxin at baseline . Propensity scores for digoxin use were estimated for each of these 2706 patients and used to assemble a cohort of 878 pairs of patients receiving and not receiving digoxin , who were balanced on 59 baseline characteristics . Matched patients had a mean age of 70 years , 40 % were women , and 11 % non-white . During the 3.4 years of the mean follow-up , all-cause mortality occurred in 14 and 13 % of matched patients receiving and not receiving digoxin , respectively [ hazard ratio ( HR ) associated with digoxin use : 1.06 ; 95 % confidence interval ( CI ) : 0.83 - 1.37 ; P = 0.640 ] . Among matched patients , digoxin had no association with all-cause hospitalization ( HR : 0.96 ; 95 % CI : 0.85 - 1.09 ; P = 0.510 ) or incident non-fatal cardiac arrhythmias ( HR : 0.90 ; 95 % CI : 0.37 - 2.23 ; P = 0.827 ) . Digoxin had no multivariable-adjusted or propensity score-adjusted associations with these outcomes in the pre-match cohort . CONCLUSIONS In patients with paroxysmal and persistent AF , we found no evidence of increased mortality or hospitalization in those taking digoxin as baseline initial therapy
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 .