title: Digoxin use and risk of mortality in hypertensive patients with atrial fibrillation.
abstract: BACKGROUND
  Digoxin is widely used for rate control of atrial fibrillation. However, recent studies have reported conflicting results on the association of digoxin with mortality when used in patients with atrial fibrillation. Moreover, the relationship of digoxin use to mortality in hypertensive patients with atrial fibrillation has not been examined.
  
  
  RESULTS
  All-cause mortality was examined in relation to in-treatment digoxin use in 937 hypertensive patients with ECG left ventricular hypertrophy in atrial fibrillation at baseline (n = 134) or who developed atrial fibrillation during follow-up (n = 803), randomly assigned to losartan or atenolol-based treatment, in post-hoc analysis of a substudy of the Losartan Intervention For Endpoint Reduction in hypertension (LIFE) trial. During 4.7 ± 1.1 years of mean follow-up, 167 patients died (17.8%) and 372 (39.7%) were treated with digoxin. In univariate Cox analyses, in-treatment digoxin use, entered as a time-varying covariate, was associated with a 61% higher risk of dying (hazard ratio 1.61, 95% confidence interval 1.18-2.19, P = 0.003). After adjusting for other univariate predictors of death in this population, including age, diabetes, history of ischemic heart disease, stroke, or heart failure, baseline Cornell product, QRS duration, heart rate, serum glucose, creatinine and high-density lipoprotein cholesterol, and a propensity score for digoxin use entered as standard covariates, and for in-treatment heart rate, pulse pressure, and Sokolow-Lyon voltage treated as time-varying covariates, digoxin use was no longer a significant predictor of mortality (hazard ratio 1.04, 95% confidence interval 0.73-1.48, P = 0.839).
  
  
  CONCLUSIONS
  In hypertensive patients with ECG left ventricular hypertrophy with existing or new atrial fibrillation, digoxin use is not associated with a significantly increased risk of all-cause mortality after adjusting for other independent predictors of death and for the factors associated with the propensity to use digoxin in this population. These findings suggest that factors other than digoxin use may account for the increased mortality found with digoxin use in some studies.
  
  
  BACKGROUND
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authors: aGreenberg Division of Cardiology, Weill Cornell Medical College, New York bMerck Research Laboratories, West Point, Pennsylvania, USA cDepartment of Medicine, Glostrup University Hospital, Glostrup, Denmark dDepartment of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway eResearch Unit, Department of Medicine, Skellefteå Hospital Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden fDepartment of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden.
authors: Peter M
authors: PM
authors: Okin
authors: Darcy A
authors: DA
authors: Hille
authors: Kristian
authors: K
authors: Wachtell
authors: Sverre E
authors: SE
authors: Kjeldsen
authors: Kurt
authors: K
authors: Boman
authors: Björn
authors: B
authors: Dahlöf
authors: Richard B
authors: RB
authors: Devereux
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001262:Atenolol / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D001794:Blood Pressure; D004077:Digoxin / Q000009:adverse effects* / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000188:drug therapy; D008075:Lipoproteins, HDL / Q000097:blood; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012306:Risk
chemical_list: D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D008075:Lipoproteins, HDL; D001262:Atenolol; D004077:Digoxin; D019808:Losartan