Real-life use of digoxin in patients with non-valvular atrial fibrillation: data from the RAMSES study.
OBJECTIVE
Although inappropriate use of digoxin has been described in various populations, a real-world evaluation of patterns of digoxin prescription has not been well studied in patients with atrial fibrillation (AF). The aim of this study was to identify prevalence, indications and appropriateness of digoxin use in the general population of patients with non-valvular AF (NVAF) in Turkey.


METHODS
We included and classified patients from the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke prevention strategies in Turkey) study, a prospective registry including 6273 patients with NVAF, on the basis of digoxin use. After excluding the data of 73 patients whose medical history about digoxin use or left ventricle function was absent, 6200 patients were included for the final analysis. Digoxin use was considered inappropriate if patients did not have left ventricular systolic dysfunction or symptomatic heart failure (HF).


CONCLUSIONS
Digoxin was used in 1274 (20·5%) patients. Patients treated with digoxin were older (71·4 ± 9·8 years vs. 69·2 ± 10·9 years, P < 0·001), more likely to be female (58·8% vs. 55·9%, P = 0·019) and had more common comorbidities such as HF (40·2% vs. 17·4%), diabetes (26·4% vs. 21·1%), coronary artery disease (35·3 vs. 27·6%) and persistent/permanent AF (93·4% vs. 78·4%; P < 0·001 for each comparison). Of the 1274 patients, the indication of digoxin use was considered inappropriate in 762 (59·8%).


CONCLUSIONS
Our findings show that nearly one-fifth of the patients with NVAF were on digoxin therapy and nearly 60% of these patients were receiving digoxin with inappropriate indications in a real-world setting.
Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey.
M
M
Biteker
Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey.
Ö
Ö
Başaran
Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Muğla, Turkey. drvolkandogan@hotmail.com.
V
V
Dogan
Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey.
O
O
Beton
Department of Cardiology, Kahramanmaraş Necip Fazıl State Hospital, Kahramanmaraş, Turkey.
M
M
Tekinalp
Department of Cardiology, Trabzon Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey.
A
A
Çağrı Aykan
Department of Cardiology, Trabzon Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey.
E
E
Kalaycıoğlu
Department of Cardiology, Fethiye State Hospital, Muğla, Turkey.
I
I
Bolat
Department of Cardiology, Elazığ Education and Research Hospital, Elazig, Turkey.
O
O
TaŞar
Department of Cardiology, Burdur State Hospital, Burdur, Turkey.
Ö
Ö
Şafak
Department of Cardiology, İskilip Atıf Hoca State Hospital, İskilip, Turkey.
M
M
Kalçık
Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey.
M
M
Yaman
Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
C
C
Kırma
D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy*; D015897:Comorbidity; D004077:Digoxin / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006352:Heart Ventricles / Q000187:drug effects; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy; D014421:Turkey
D004077:Digoxin
atrial fibrillation; congestive heart failure; digoxin