Digoxin Is Associated With Increased All-cause Mortality in Patients With Atrial Fibrillation Regardless of Concomitant Heart Failure: A Meta-analysis.
For decades, digoxin has been widely used to control ventricular rate in atrial fibrillation (AF). However, it remains controversial as to whether digoxin is associated with increased mortality in AF. In this study, we searched relevant studies that were published before December 1, 2014, in PubMed, EMBASE, and the Cochrane central databases. We systematically reviewed the references and performed a meta-analysis of 8 carefully selected studies with 302,738 patients who were included for the final analysis. It was shown that digoxin use was associated with increased risk of all-cause mortality in AF overall [hazard ratio (HR) = 1.375, 95% confidence intervals (CI), 1.201-1.574, P = 0.0001]. Subgroup analysis further revealed that digoxin was associated with increased all-cause mortality in patients with AF, which was complicated by heart failure (HF) (HR = 1.201, CI, 1.074- 1.344, P = 0.001), and in those subjects without HF (HR = 1.172, CI, 1.148-1.198, P = 0.0001). Sensitivity analyses found results to be robust. Our findings indicated that digoxin use was associated with significantly increased all-cause mortality in patients with AF regardless of concomitant HF. We suggest that digoxin should not be preferentially used over other rate control medications in AF.
Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Zhi-Quan
ZQ
Wang
Rui
R
Zhang
Man-Tian
MT
Chen
Qun-Shan
QS
Wang
Yi
Y
Zhang
Xiao-Hong
XH
Huang
Jun
J
Wang
Jian-Hua
JH
Yan
Yi-Gang
YG
Li
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D004077:Digoxin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D009026:Mortality / Q000639:trends
D000889:Anti-Arrhythmia Agents; D004077:Digoxin