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Journal of the American College of Cardiology

Clinical Articles, News & Views

Digoxin linked to mortality in patients with AF: the TREAT-AF study

Digoxin is associated with increased risk of death in patients with newly diagnosed atrial fibrillation (AF), independent of drug adherence, kidney function, cardiovascular comorbidities, and concomitant therapies, according to a study published recently in the Journal of the American College of Cardiology.1

Using complete data of the TREAT-AF (The Retrospective Evaluation and Assessment of Therapies in AF) study from the US Department of Veterans Affairs (VA) healthcare system, the authors identified patients with newly diagnosed, non-valvular AF seen within 90 days in an outpatient setting between VA fiscal years 2004 and 2008. They used multivariate and propensity-matched Cox proportional hazards to evaluate the association of digoxin use with death. Residual confounding was assessed by sensitivity analysis.

Of 122,465 patients with 353,168 person-years of follow-up (age 72.1 ± 10.3 years, 98.4% male), 28,679 (23.4%) patients received digoxin. Cumulative mortality rates were higher for digoxin-treated patients than for untreated patients (95 vs. 67 per 1,000 person-years; p < 0.001). Digoxin use was independently associated with mortality after multivariate adjustment (hazard ratio [HR]: 1.26, 95% confidence interval [CI]: 1.23 to 1.29, p < 0.001) and propensity matching (HR: 1.21, 95% CI: 1.17 to 1.25, p < 0.001), even after adjustment for drug adherence. The risk of death was not modified by age, sex, heart failure, kidney function, or concomitant use of beta-blockers, amiodarone, or warfarin.


1. Turakhia MP, Santangeli P, Winkelmayer WC, et al. Increased mortality associated with digoxin in contemporary patients with atrial fibrillation: findings from the TREAT-AF study. J Am Coll Cardiol 2014;64:660–8.

Published on: September 26, 2014

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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