Abstract
Background: Digoxin is widely used in patients with atrial fibrillation (AF). Objectives: The goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with AF and if the association was modified by heart failure and/or serum digoxin concentration. Methods: The association between digoxin use and mortality was assessed in 17,897 patients by using a propensity score–adjusted analysis and in new digoxin users during the trial versus propensity score–matched control participants. The authors investigated the independent association between serum digoxin concentration and mortality after multivariable adjustment. Results: At baseline, 5,824 (32.5%) patients were receiving digoxin. Baseline digoxin use was not associated with an increased risk of death (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 0.96 to 1.23; p = 0.19). However, patients with a serum digoxin concentration ≥1.2 ng/ml had a 56% increased hazard of mortality (adjusted HR: 1.56; 95% CI: 1.20 to 2.04) compared with those not on digoxin. When analyzed as a continuous variable, serum digoxin concentration was associated with a 19% higher adjusted hazard of death for each 0.5-ng/ml increase (p = 0.0010); these results were similar for patients with and without heart failure. Compared with propensity score–matched control participants, the risk of death (adjusted HR: 1.78; 95% CI: 1.37 to 2.31) and sudden death (adjusted HR: 2.14; 95% CI: 1.11 to 4.12) was significantly higher in new digoxin users. Conclusions: In patients with AF taking digoxin, the risk of death was independently related to serum digoxin concentration and was highest in patients with concentrations ≥1.2 ng/ml. Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure.
| Original language | English |
|---|---|
| Pages (from-to) | 1063-1074 |
| Number of pages | 12 |
| Journal | Journal of the American College of Cardiology |
| Volume | 71 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Mar 13 2018 |
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Keywords
- atrial fibrillation
- digoxin
- heart failure
- mortality
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Digoxin and Mortality in Patients With Atrial Fibrillation. / for the.
In: Journal of the American College of Cardiology, Vol. 71, No. 10, 13.03.2018, p. 1063-1074.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Digoxin and Mortality in Patients With Atrial Fibrillation
AU - for the
AU - Lopes, Renato D.
AU - Rordorf, Roberto
AU - De Ferrari, Gaetano M.
AU - Leonardi, Sergio
AU - Thomas, Laine
AU - Wojdyla, Daniel M.
AU - Ridefelt, Peter
AU - Lawrence, John H.
AU - De Caterina, Raffaele
AU - Vinereanu, Dragos
AU - Hanna, Michael
AU - Flaker, Greg
AU - Al-Khatib, Sana M.
AU - Hohnloser, Stefan H.
AU - Alexander, John H.
AU - Granger, Christopher B.
AU - Wallentin, Lars
PY - 2018/3/13
Y1 - 2018/3/13
N2 - Background: Digoxin is widely used in patients with atrial fibrillation (AF). Objectives: The goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with AF and if the association was modified by heart failure and/or serum digoxin concentration. Methods: The association between digoxin use and mortality was assessed in 17,897 patients by using a propensity score–adjusted analysis and in new digoxin users during the trial versus propensity score–matched control participants. The authors investigated the independent association between serum digoxin concentration and mortality after multivariable adjustment. Results: At baseline, 5,824 (32.5%) patients were receiving digoxin. Baseline digoxin use was not associated with an increased risk of death (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 0.96 to 1.23; p = 0.19). However, patients with a serum digoxin concentration ≥1.2 ng/ml had a 56% increased hazard of mortality (adjusted HR: 1.56; 95% CI: 1.20 to 2.04) compared with those not on digoxin. When analyzed as a continuous variable, serum digoxin concentration was associated with a 19% higher adjusted hazard of death for each 0.5-ng/ml increase (p = 0.0010); these results were similar for patients with and without heart failure. Compared with propensity score–matched control participants, the risk of death (adjusted HR: 1.78; 95% CI: 1.37 to 2.31) and sudden death (adjusted HR: 2.14; 95% CI: 1.11 to 4.12) was significantly higher in new digoxin users. Conclusions: In patients with AF taking digoxin, the risk of death was independently related to serum digoxin concentration and was highest in patients with concentrations ≥1.2 ng/ml. Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure.
AB - Background: Digoxin is widely used in patients with atrial fibrillation (AF). Objectives: The goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with AF and if the association was modified by heart failure and/or serum digoxin concentration. Methods: The association between digoxin use and mortality was assessed in 17,897 patients by using a propensity score–adjusted analysis and in new digoxin users during the trial versus propensity score–matched control participants. The authors investigated the independent association between serum digoxin concentration and mortality after multivariable adjustment. Results: At baseline, 5,824 (32.5%) patients were receiving digoxin. Baseline digoxin use was not associated with an increased risk of death (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 0.96 to 1.23; p = 0.19). However, patients with a serum digoxin concentration ≥1.2 ng/ml had a 56% increased hazard of mortality (adjusted HR: 1.56; 95% CI: 1.20 to 2.04) compared with those not on digoxin. When analyzed as a continuous variable, serum digoxin concentration was associated with a 19% higher adjusted hazard of death for each 0.5-ng/ml increase (p = 0.0010); these results were similar for patients with and without heart failure. Compared with propensity score–matched control participants, the risk of death (adjusted HR: 1.78; 95% CI: 1.37 to 2.31) and sudden death (adjusted HR: 2.14; 95% CI: 1.11 to 4.12) was significantly higher in new digoxin users. Conclusions: In patients with AF taking digoxin, the risk of death was independently related to serum digoxin concentration and was highest in patients with concentrations ≥1.2 ng/ml. Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure.
KW - atrial fibrillation
KW - digoxin
KW - heart failure
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85042306799&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85042306799&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2017.12.060
DO - 10.1016/j.jacc.2017.12.060
M3 - Article
AN - SCOPUS:85042306799
VL - 71
SP - 1063
EP - 1074
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 10
ER -