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 .
Effect of oral digoxin in high-risk heart failure patients: a pre-specified subgroup analysis of the DIG trial.
AIMS In the Digitalis Investigation Group ( DIG ) trial , digoxin reduced mortality or hospitalization due to heart failure  ( HF ) in several pre-specified high-risk subgroups of HF patients , but data on protocol -specified 2-year outcomes were not presented . In the current study , we examined the effect of digoxin on HF death or HF hospitalization and all-cause death or all-cause hospitalization in high-risk subgroups during the protocol -specified 2 years of post-r and omization follow-up . METHODS AND RESULTS In the DIG trial , 6800 ambulatory patients with chronic HF , normal sinus rhythm , and LVEF ≤45 % ( mean age 64 years , 26 % women , 17 % non-whites ) were r and omized to receive digoxin or placebo .  The three high-risk groups were defined as NYHA class III-IV symptoms ( n = 2223 ) , LVEF < 25 % ( n = 2256 ) , and cardiothoracic ratio ( CTR ) > 55 % ( n = 2345 ) . In all three high-risk subgroups , compared with patients in the placebo group , those in the digoxin group had a significant reduction in the risk of the 2-year composite endpoint of HF mortality or HF hospitalization : NYHA III-IV [ hazard ratio ( HR ) 0.65 ; 95 % confidence interval ( CI ) 0.57 - 0.75 ; P < 0.001 ] , LVEF < 25 % ( HR 0.61 ; 95 % CI 0.53 - 0.71 ; P < 0.001 ) , and CTR > 55 % ( HR 0.65 ; 95 % CI 0.57 - 0.75 ; P < 0.001 ) .  Digoxin-associated HRs ( 95 % CI ) for 2-year all-cause mortality or all-cause hospitalization for subgroups with NYHA III-IV , LVEF < 25 % , and CTR > 55 % were 0.88 ( 0.80 - 0.97 ; P = 0.012 ) , 0.84 ( 0.76 - 0.93 ; P = 0.001 ) , and 0.85 ( 0.77 - 0.94 ; P = 0.002 ) , respectively . CONCLUSIONS Digoxin  improves outcomes in chronic HF patients with NYHA class III-IV , LVEF < 25 % , or CTR > 55 % , and should be considered in these patients
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 .