Digoxin and short term mortality after acute STEMI: Results from the MAGIC trial

Metawee, Mohamed; Charnigo, Richard; Morales, Gustavo; Darrat, Yousef; Sorrell, Vincent L.; Biase, Luigi Di; Delisle, Brian P.; Elayi, Claude S.

doi:10.1016/j.ijcard.2016.05.022

Cited by 13 publications

(8 citation statements)

References 24 publications

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“…Garvia-Rubira et al found that previous digoxin treatment did not influence the in-hospital mortality of acute coronary syndrome patients, 9 and Metawee et al observed no association between digoxin and 30-day mortality in STEMI patients. 10 We found that post-MI digoxin usage was significantly associated with increased long-term mortality after MI in AF patients, with an NNH of 16.7 for death after adjustment for many potential confounders. To our knowledge, the current study, with a median follow-up period of 7.4 years, is the first contemporary long-term analysis of digoxin use and clinical outcomes after acute MI, and it is among the first to focus on AF patients.…”

Section: Discussionmentioning

confidence: 67%

Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation

Kytö

Saraste

Rautava

et al. 2022

Basic Clin Pharma Tox

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Digoxin is used for rate control in atrial fibrillation (AF), but evidence for its efficacy and safety after myocardial infarction (MI) is scarce and mixed. We studied post‐MI digoxin use effects on AF patient outcomes in a nationwide registry follow‐up study in Finland. Digoxin was used by 18.6% of AF patients after MI, with a decreasing usage trend during 2004–2014. Baseline differences in digoxin users (n = 881) and controls (n = 3898) were balanced with inverse probability of treatment weight adjustment. The median follow‐up was 7.4 years. Patients using digoxin after MI had a higher cumulative all‐cause mortality (77.4% vs. 72.3%; hazard ratio [HR]: 1.19; confidence interval [CI]: 1.07–1.32; p = 0.001) during a 10‐year follow‐up. Mortality differences were detected in a subgroup analysis of patients without baseline heart failure (HF) (HR: 1.23; p = 0.019) but not in patients with baseline HF (HR: 1.05; p = 0.413). Cumulative incidences of HF hospitalizations, stroke and new MI were similar between digoxin group and controls. In conclusion, digoxin use after MI is associated with increased mortality but not with HF hospitalizations, new MI or stroke in AF patients. Increased mortality was detected in patients without baseline HF. Results suggest caution with digoxin after MI in AF patients, especially in the absence of HF.

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Section: Discussionmentioning

confidence: 67%

Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation

Kytö

Saraste

Rautava

et al. 2022

Basic Clin Pharma Tox

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“…The 10 systematic reviews included a total of 41 unique studies in AF (with or without HF) populations that reported all‐cause mortality (Table ), representing 40% of all studies included in these reviews 19,24–64 . Of these AF studies, 41% ( n = 17) were cohort studies, 29% ( n = 12) were post hoc analyses of RCTs, 15% ( n = 6) were RCTs, and 15% ( n = 6) were registry studies.…”

Section: Resultsmentioning

confidence: 99%

Influence of digoxin on mortality in patients with atrial fibrillation: Overview of systematic reviews

2021

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Once a routine part of atrial fibrillation (AF) management, digoxin use has declined.Likely hastening this decline are findings from several studies and systematic reviews identifying a potential association between digoxin use and all-cause mortality in AF populations. However, inconsistency exists within some of these studies potentially leading to confusion among clinicians. To critically evaluate the current literature to contextualize the associations between digoxin and mortality risk in patients with AF by performing an overview of systematic reviews. We searched MEDLINE, Cochrane Central Database of Systematic Reviews, and SCOPUS from their earliest date through October 12, 2020, to identify systematic reviews (SRs) that included studies enrolling patients with AF or atrial flutter and evaluated the association between digoxin use and all-cause mortality. We used the AMSTAR 2 tool to assess the risk of bias for each included SR. Results from reviews are qualitatively synthesized. Our search identified 10 SRs that met our inclusion criteria. Of the 41 unique AF studies included in these SRs, 41% were cohort studies, 29% were post hoc analyses of randomized controlled trials (RCTs), 15% were RCTs, and 15% were registry studies. Based on our AMSTAR 2 assessment, the overall confidence in the results of the 10 reviews was rated as "moderate" in three SRs, "low" in three SRs, and "critically low" in the rest. Except for one review, each included SR shows that digoxin use in AF is associated with a 15 to 38% higher risk of all-cause mortality. This association may be greater when AFonly populations are considered compared with a mix of AF and heart failure populations. Serum digoxin concentration (SDC) data were infrequently considered, but available data suggested a greater association between increasing SDC and all-cause mortality. This overview of reviews found general consistency regarding the association between digoxin use and higher all-cause mortality in AF populations. However, heterogeneity exists among and between SRs and an unmet need exists for additional study in a RCT setting with close monitoring and reporting of SDC to better inform clinical practice.

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“…The MAGIC trial [ 12 ] consisted of 57.4% male patients with a CHA 2 DS 2 -VASc score of 3, combined β-blocker treatment (40.7% vs. 40.9%) and amiodarone treatment (31.9% vs. 9.9%). Their results were limited by not presenting the maintenance digoxin dose, SDC and renal function status between the digoxin and non-digoxin groups.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, this mortality risk seems to increase in digoxin-treated AF patients with pre-existing ischemic heart disease (IHD) [ 7 , 11 ]. However, in the MAGIC (Medical Research Council Adjuvant Gastric Infusional Chemotherap) trial, digoxin treatment was not associated with a significant increase in cardiac mortality over the course of a one-month follow-up [ 12 ]. Because there is limited long-term data on the major determinants for digoxin-associated mortality in AF patients, we performed a retrospective analysis of a large cohort of AF patients and clarified the major clinical determinants of cardiac and cerebrovascular mortality in AF patients chronically treated with digoxin.…”

Section: Introductionmentioning

confidence: 99%

Concurrent renal dysfunction with ischemic heart disease is an important determinant for cardiac and cerebrovascular mortality in patients on chronic digoxin therapy for atrial fibrillation

Shin

Kang

Kim

et al. 2018

Kidney Res Clin Pract.

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BackgroundMajor adverse cardiac and cerebrovascular events (MACCEs) are main concerns in patients with atrial fibrillation (AF); however, factors affecting MACCEs remain inconclusive in AF patients chronically treated with digoxin. We investigated the major clinical determinants for fatal MACCEs in AF patients treated with digoxin over a 10-year follow-up period.MethodsWe analyzed a retrospective cohort of 1,480 AF patients at Eulji University Hospital, Daejeon, South Korea from March 2004 to August 2015. Among this population, 402 consecutive patients receiving chronic digoxin therapy were selected for the study. Data for electrocardiography, medication history, laboratory values including the serum digoxin concentration (SDC) and fatal MACCEs were collected. All data were divided and compared between groups based on the occurrence of MACCEs.ResultsThe overall incidence of fatal MACCEs among the 402 digoxin-treated AF patients (age, 68 ± 11 years; male, 40.3%) was 12.1%. These fatalities resulted from heart failure (46.1%), fatal stroke (26.9%), fatal myocardial infarction (15.3%) and sudden cardiac death (5.7%). A higher prevalence of diabetes, pre-existing ischemic heart disease (IHD), lower estimated glomerular filtration rate (eGFR), higher SDC, and junctional bradycardia were more frequently observed in patients with MACCEs compared to those without MACCEs. Multivariable analysis showed that an eGFR of ≤ 60 mL/min/1.73 m2 and pre-existing IHD had a hazard ratio of 3.35 and a confidence interval of 1.64–6.87 (P < 0.001) for fatal MACCEs.ConclusionChronic kidney disease stage III–V with pre-existing IHD is significantly associated with increased cardiac and cerebrovascular mortality in AF patients with chronic digoxin use.

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Digoxin and short term mortality after acute STEMI: Results from the MAGIC trial

Cited by 13 publications

References 24 publications

Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation

Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation

Influence of digoxin on mortality in patients with atrial fibrillation: Overview of systematic reviews

Concurrent renal dysfunction with ischemic heart disease is an important determinant for cardiac and cerebrovascular mortality in patients on chronic digoxin therapy for atrial fibrillation

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