Digoxin in AF

strike for digoxin in AF: Mortality goes up/cohort study

teve Stiles

San Francisco, CA - Patients with atrial fibrillation (AF) starting digoxin for the first time showed an independently significant jump in mortality over an average of one year compared with nondigoxin users in an observational study reported here today at the American College of Cardiology 2013 Scientific Sessions. Stratified analysis showed the effect to be consistent in men and women and by age.

Digoxin was given for rate control; patients with heart failure had been excluded from the study.

Although mortality doubled with digoxin use, hospitalizations appeared unaffected, suggesting that the people died at home, according to lead author Dr James V Freeman (Stanford University School of Medicine, CA). And though there were no data on cause of death, he toldheartwire that ventricular arrhythmias are a hazard from digoxin toxicity, "so our hypothesis is that maybe [digoxin users] had an increase in arrhythmic death and sudden cardiac death. But there's no way to know that for certain."

Digoxin in one form or another is one of the oldest still-used drugs in medicine and was never tested in substantial clinical trials for efficacy or safety in AF. Still, Freeman observed, the drug "is much more commonly used than people think, and it's not just that people who were using it 20 years ago are still using it."

The current findings support a recent propensity-adjusted secondary analysis of the AFFIRM trial, which found a 41% jump in all-cause mortality in AF patients taking vs not taking digoxin. As previously reported by heartwire, the increased hazard was seen in both men and women and in patients with and wit/.../