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Clinical Articles, News & Views

Digoxin-associated mortality: a systematic review

Digoxin use is associated with an increased mortality risk, particularly among patients suffering from atrial fibrillation (AF), according to a report published recently in the European Heart Journal.1

Authors performed a MEDLINE and a COCHRANE search (1993–2014) of the English literature dealing with the effects of digoxin on all-cause-mortality in subjects with AF or chronic heart failure (CHF). Only full-sized articles published in peer-reviewed journals were considered for this meta-analysis. A total of 19 reports were identified.

Nine reports dealt with AF patients, seven with patients suffering from CHF, and three with both clinical conditions. Based on the analysis of adjusted mortality results of all 19 studies comprising 326,426 patients, digoxin use was associated with an increased relative risk of all-cause mortality [Hazard ratio (HR) 1.21, 95% confidence interval (CI), 1.07 to 1.38, P , 0.01].

Compared with subjects not receiving glycosides, digoxin was associated with a 29% increased mortality risk (HR 1.29; 95% CI, 1.21 to 1.39) in the subgroup of publications comprising 235,047 AF patients. Among 91,379 heart failure patients, digoxin-associated mortality risk increased by 14% (HR 1.14, 95% CI, 1.06 to 1.22).

Their sensitivity analysis, the authors state, “suggests negative effects of digoxin particularly in the AF population but somewhat less unfavourable effects in the CHF population”. Until randomised controlled trials of dose-adjusted digoxin therapy are performed, the drug should be used with great caution, particularly when administered for rate control in AF, they conclude.


1. Vamos M, Erath JW, Hohnloser SH. Digoxin-associated mortality: a systematic review and meta-analysis of the literature. Euro Heart J 2015;36:1831–8.

Published on: July 30, 2015

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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