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Circulation: Arrhythmia and Electrophysiology

Clinical Articles, Lead Article

Digoxin can increase risk of death in AF

In adults with atrial fibrillation (AF), digoxin use is independently associated with higher risks of death and hospitalisation, according to a study published recently in Circulation: Arrhythmia and Electrophysiology.1

Researchers performed a retrospective cohort study of 14,787 age, gender and high-dimensional propensity score-matched adults with incident AF and no prior heart failure or digoxin use in the ATRIA-CVRN (AnTicoagulation and Risk factors In Atrial fibrillation-Cardiovascular Research Network) study within Kaiser Permanente Northern and Southern California. They examined the independent association between newly initiated digoxin and the risks of death and hospitalisation using extended Cox regression.

The ATRIA-CVRN Study2

During a median 1.17 (interquartile range 0.49-1.97) years of follow-up among matched patients with AF, incident digoxin use was associated with higher rates of death (8.3 vs. 4.9 per 100 person-years, P<0.001) and hospitalisation (60.1 vs. 37.2 per 100 person-years, P<0.001). Incident digoxin use was independently associated with a 71% higher risk of death (hazard ratio [HR] 1.71, 95%CI:1.52-1.93) and a 63% higher risk of hospitalisation (HR 1.63, 95%CI:1.56-1.71). Results were consistent in subgroups of age and gender and when using “intent-to-treat” or “on-treatment” analytic approaches.

Given other available rate control options, digoxin should be used with caution in the management of AF, the authors conclude.

References

1. Freeman JV, Reynolds K, Fang M, et al. Digoxin and risk of death in adults with atrial fibrillation: the ATRIA-CVRN study. Circ Arrhythm Electrophysiol 2014. http://dx.doi.org/10.1161/CIRCEP.114.002292

Published on: December 19, 2014

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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