title: Digoxin Use and Subsequent Outcomes Among Patients in a Contemporary Atrial Fibrillation Cohort.
abstract: BACKGROUND
  Although digoxin has long been used to treat atrial fibrillation (AF) and heart failure (HF), its safety remains controversial.
  
  
  OBJECTIVE
  This study sought to describe digoxin use over time in patients with AF who were stratified by the presence or absence of HF, to characterize the predictors of digoxin use and initiation, and to correlate digoxin use with outcomes.
  
  
  METHODS
  Longitudinal patterns of digoxin use and its association with a variety of outcomes were assessed in a prospective outpatient registry conducted at 174 U.S. sites with enrollment from June 2010 to August 2011.
  
  
  RESULTS
  Among 9,619 patients with AF and serial follow-up every 6 months for up to 3 years, 2,267 (23.6%) received digoxin at study enrollment, 681 (7.1%) were initiated on digoxin during follow-up, and 6,671 (69.4%) were never prescribed digoxin. After adjusting for other medications, heart rate was 72.9 beats/min among digoxin users and 71.5 beats/min among nonusers (p < 0.0001). Prevalent digoxin use at registry enrollment was not associated with subsequent onset of symptoms, hospitalization, or mortality (in patients with HF, adjusted hazard ratio [HR] for death: 1.04; without HF, HR: 1.22). Incident digoxin use during follow-up was not associated with subsequent death in patients with HF (propensity adjusted HR: 1.05), but was associated with subsequent death in those without HF (propensity adjusted HR: 1.99).
  
  
  CONCLUSIONS
  After adjustment for detailed clinical factors, digoxin use in registry patients with AF had a neutral association with outcomes under most circumstances. Because of the multiple conflicting observational reports about digoxin's safety and possible concerns in specific clinical situations, a large pragmatic trial of digoxin therapy in AF is needed.
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado. Electronic address: larry.allen@ucdenver.edu.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: University of California, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: DaJuanicia N
authors.initials: DN
authors.lastname: Simon
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Laine E
authors.initials: LE
authors.lastname: Thomas
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Lucas N
authors.initials: LN
authors.lastname: Marzec
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Pokorney
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: Kaiser Permanente Northern California, Oakland, California.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hylek
authors.affiliation: Lankenau Heart Institute and the Jefferson Medical College, Philadelphia, Pennsylvania.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
authors.affiliation: Stanford University School of Medicine, Palo Alto, California.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.affiliation: Janssen Scientific Affairs, Raritan, New Jersey.
authors.forename: Paul
authors.initials: P
authors.lastname: Chang
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004077:Digoxin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004077:Digoxin
keywords: heart failure; mortality; patient outcome assessment; safety