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Digoxin may raise risk for death in patients with newly diagnosed AF

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The use of digoxin was associated with increased risk for mortality in patients with newly diagnosed atrial fibrillation, according to new data from the TREAT-AF study.

This association was independent of age, sex, drug compliance, kidney function, HF status and concomitant treatment regimens.

Researchers evaluated data from 122,465 participants from TREAT-AF, an analysis of patients with newly diagnosed AF treated in an inpatient setting within 90 days at the US Department of Veterans Affairs from 2004 to 2008. The cohort was 98.4% male and the mean age was 72 years.

In total, 28,679 patients (23.4%) received digoxin. Digoxin-treated patients had increased cumulative mortality rates compared with untreated patients (95 vs. 67 per 1,000 person-years; P<.001), according to the results. The association between digoxin use and mortality remained consistent after multivariate adjustment (HR=1.26; 95% CI, 1.23-1.29) and propensity matching (HR=1.21; 95% CI, 1.17-1.25), and was independent of drug adherence.

“These findings challenge the current cardiovascular society guidelines, which give class I and class IIa recommendations for the use of digoxin as an adjunct to rate control monotherapy,” Mintu P. Turakhia, MD, MAS, from the Veterans Affairs Palo Alto Health Care System and the division of cardiovascular medicine at Stanford University School of Medicine, and colleagues concluded.

While the findings underscore the need for selective digoxin use in patients with AF, the data do not prove that treatment should be discontinued entirely, Matthew R. Reynolds, MD, from the division of cardiology at Lahey Hospital and Medical Center, Burlington, Mass., wrote in an accompanying editorial.

“Should the use of digoxin for rate control in AF be abandoned altogether? Such a recommendation cannot be made on the basis of this kind of observational data.

“Going forward, the role of digoxin in AF treatment may continue to diminish. For now, there are still clinical circumstances (HF, difficult rate control, low blood pressure) where this old herbal remedy remains useful,” Reynolds wrote.

For more information:

Reynolds MR. J Am Coll Cardiol. 2014;64:669-671.

Turakhia MP. J Am Coll Cardiol. 2014;64:660-668.

Disclosure: The researchers and Reynolds report no relevant financial disclosures.