Digoxin was associated with increased mortality risk in US veterans newly diagnosed with atrial fibrillation/atrial flutter (AF) independent of drug adherence, kidney function, cardiovascular comorbidities, or concomitant therapies with β-blockers or amiodarone, according to a retrospective cohort study of 122 465 individuals with 353 168 person-years of follow-up (Turakhia M et al. J Am Coll Cardiol. 2014;64:660-668).
Among the study participants, 23.4% received digoxin during the first 90 days after initial AF diagnosis. They had a higher prevalence of heart failure (HF) and were more likely to receive β-blockers, angiotensin receptor blockers, antiplatelet therapy, diuretic agents, and warfarin compared with individuals not taking digoxin. Digoxin was significantly associated with death after propensity matching, even after adjustment for drug adherence. The findings challenge existing guidelines and practice for AF, particularly when digoxin is being used as initial or early therapy, the authors stated.
Slomski A. Digoxin Linked to Higher Mortality in Some Patients With Atrial Fibrillation. JAMA. 2014;312(12):1184. doi:10.1001/jama.2014.13081