Digoxin Use and Adverse Outcomes in Patients With Atrial Fibrillation

Abstract

Digoxin has long been used for rate control in atrial fibrillation (AF); its safety remains controversial.We performed a literature search using MEDLINE (source PubMed, January 1, 1966, to July 31, 2015) and EMBASE (January 1, 1980, to July 31, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Pooled effect estimates were obtained by using random-effects meta-analysis.Twenty-two studies involving 586,594 patients were identified. Patients taking digoxin, as compared with those who took no digoxin, experienced an increased risk of death from any cause (RR: 1.29[95% CI 1.16–1.43]), even after reported adjustment for propensity scores (RR: 1.28[95% CI 1.18–1.39]). The risk of death was increased with patients with or without heart failure (RR: 1.12[95% CI 1.02–1.23] and RR: 1.26[95% CI 1.15–1.29], respectively), and patients taking or not taking beta blockers (RR: 1.17 [95% CI 1.06–1.30] and RR: 1.28 [95% CI 1.08–1.51], respectively). Digoxin use was also associated with increased risk of cardiovascular death (RR: 1.32 [95% CI 1.07–1.64]), arrhythmic death (RR: 1.38 [95% CI 1.07–1.79]), and stroke (RR: 1.20 [95% CI 1.004–1.44]). Digoxin treatment is associated with an absolute risk increase of 19 (95% CI 13–26) additional deaths from any cause per 1000 person-years.Digoxin use is associated with a significant increased risk for death from any cause in patients with AF. This finding suggests a need for reconsideration of present treatment recommendations on use of digoxin in AF.

Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin‐Fab

“…Digoxin has been used in the management of congestive cardiac failure and long‐term rate control of atrial fibrillation for decades. Despite a reduction in its use due to the introduction of newer agents, such as beta‐blockers and calcium channel blockers, digoxin toxicity still remains a common cause of morbidity and mortality . Consisting of a narrow therapeutic index, it is the seventh most common medication implicated in ED presentations from drug toxicity and has the highest proportion of ED visits resulting in medication‐related hospitalisation …”

“…Despite a reduction in its use due to the introduction of newer agents, such as beta-blockers and calcium channel blockers, digoxin toxicity still remains a common cause of morbidity and mortality. 1,2 Consisting of a narrow therapeutic index, it is the seventh most common medication implicated in ED presentations from drug toxicity and has the highest proportion of ED visits resulting in medication-related hospitalisation. 3 Digoxin-Fab [Digoxin Immune Fab (Ovine)] is a sterile, purified, lyophilised preparation of digoxinimmune ovine Fab (monovalent) immunoglobulin fragments.…”

Novel rate control strategy with landiolol in patients with cardiac dysfunction and atrial fibrillation

“…12 Furthermore, digoxin might be proarrhythmic provoking delayed after depolarization especially in failing myocytes. 13 Amiodarone might also be considered, but it would be insufficient for rapid rate control even during the intravenous infusion. 14 We should also be cautious about its serious adverse drug effects including lung fibrosis and thyrotoxicosis.…”

Peculiarities of therapy for heart rhythm disorders in patients with chronic heart failure

“…Последовательно в 2013, 2014, 2015, 2016 гг. были опубликованы данные обсервационных исследований и метаанализы, показывающие, что при ем дигоксина ассоциируется с повышением смертности пациентов с хронической ФП и ХСН со сниженной ФВ, в большей степени при сохранной ФВ [30][31][32][33][34][35] Проаритмические эффекты гликозидов могут быть вызваны или усилены за счет лекарственных взаимодей ствий, например, с такими ААП, как амиодарон или хини дин [37]. Примером может служить недавнее рандоми зированное исследование дронедарона у пациентов с ФП [38].…”

“…По мнению экспертов, в свете этих фактов, а также наличия других препаратов для контроля ритма у паци ентов с ФП, таких как βАБ и ACa 2+ , лечение дигоксином не может использоваться даже с осторожностью у паци ентов с ФП до тех пор, пока адекватные рандомизирован ные исследования не завершатся [35].…”