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Digoxin linked to increased mortality risk in AF
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Often used for rate control of atrial fibrillation, a new study has linked digoxin with a significant increase in all-cause mortality among patients with AF.
Use of the drug remains controversial due to its narrow therapeutic index and potential to contribute to life-threatening ventricular tachyarrhythmias and severe bradyarrhythmias. Of particular concern are elevated serum levels of digoxin that have been correlated with increased mortality in multiple patient populations.
For this study, researchers analyzed data from 4,060 patients with AF who had enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial.
In patients with AF, digoxin was associated with increased all-cause mortality (estimated HR=1.41; 95% CI, 1.19-1.67), CV mortality (HER=1.35; 95% CI, 1.06-1.71) and arrhythmic mortality (HER=1.61; 95% CI, 1.12-2.30).
Analyses were conducted in all patients according to the presence of HF. All-cause mortality was increased with digoxin use in patients with and without HF (EHR=1.41; 95% CI, 1.09-1.84 and EHR=1.37; 95% CI, 1.05-1.79).
Additionally, the researchers found no significant interaction between digoxin use and sex for all-cause (P=.7) or CV (P=.95) mortality.
“These findings mean that physicians should try to control a patient’s heart rate by using alternatives as a first line, such as beta-blockers or calcium blockers; if digoxin is used, use a low dose with careful clinical follow-up, evaluate potential drug interactions when starting new medications and monitor digoxin levels. Patients should be aware of potential toxicity and see their physicians immediately in specific clinical situations, for instance if they experience palpitations or syncope, as those may precede arrhythmic death,” researcher Samy Claude Elayi, MD, from the division of cardiovascular medicine, Gill Heart Institute, University of Kentucky, stated in a press release.
“Our study underscores the importance of reassessing the role of digoxin in the contemporary management of AF in patients with or without HF,” said Elayi.
Disclosure: The researchers report no relevant financial disclosures.
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