Impact of Digoxin on Mortality in Patients With Atrial Fibrillation Stratified by Heart Failure: Findings From Gulf Survey of Atrial Fibrillation Events in the Middle East.
The use of digoxin in patients having atrial fibrillation (AF) with or without heart failure (HF) is not without controversy. The aim of this study was to examine the impact of digoxin therapy on mortality stratified by HF.



Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department of 23 hospitals in 6 countries in the Middle East. Patients were recruited between October 2009 and June 2010 and followed up for 1 year after enrollment. Analyses were performed using univariate and multivariate statistical techniques.



The study included a total of 1962 patients with AF, with an overall mean age of 56 ± 16 years, and 52% (n = 1026) were males. At hospital discharge, digoxin was prescribed in 36% (n = 709) of the patients, whereas HF was present in 27% (n = 528) of the cohort. A total of 225 (12.1%) patients died during the 12-month follow-up period after discharge (5.3% [n = 104] were lost to follow-up). Patients with HF were consistently associated with higher mortality at 1 month (5.1% vs 2.1%; P < .001), 6 months (17.2% vs 5.0%; P < 0.001), and 12 months (24.3% vs 7.6%; P < .001) when compared to those without HF. When stratified by HF, digoxin therapy was associated with significantly higher mortality in those without HF at 6 months (8.7% vs 3.7%; adjusted odds ratio (aOR), 5.07; P < .001) and 12 months (12.3% vs 6.0%; aOR, 4.22; P < .001) but not in those with HF (6 months: 18.6% vs 14.7%; aOR, 1.62; P = .177 and 12 months: 25.4% vs 22.4%; aOR, 1.37; P = .317).



In patients with AF and HF, digoxin did not offer any survival advantages. However, in those without HF, digoxin therapy was, in fact, associated with significantly higher long-term mortality.
Department of Pharmacology & Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman Gulf Health Research, Muscat, Oman ial_zakwani@yahoo.com.
Ibrahim
I
Al-Zakwani
Department of Cardiology, Royal Hospital, Muscat, Oman.
P
P
Panduranga
Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait.
M
M
Zubaid
Department of Cardiology, Royal Hospital, Muscat, Oman.
K
K
Sulaiman
Department of Medicine, Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait, Kuwait.
W A
WA
Rashed
Division of Adult Cardiology, Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
A A
AA
Alsheikh-Ali
Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
W
W
AlMahmeed
Department of Medicine, Faculty of Medicine, UAE University, Al Ain, United Arab Emirates.
A
A
Shehab
Cardiac Center, Al Thawra Hospital, Sana'a, Yemen.
A
A
Al Qudaimi
Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
N
N
Asaad
Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain.
H
H
Amin
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000009:adverse effects*; D004077:Digoxin / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D018579:Patient Selection; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D004077:Digoxin
atrial fibrillation; digoxin; heart failure; middle east; mortality