Although digoxin is commonly used for rate control in patients with atrial fibrillation (AF), it has been linked to greater mortality. To evaluate this relationship, the authors of a recent retrospective study examined data from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial.

The AFFIRM trial involved 4,060 patients with AF who were at high risk for stroke; 39% were women, and 27% had heart failure. Overall, 69% received digoxin; the median duration of digoxin therapy was 32 months. Many patients also received [beta]-blockers and angiotensin-converting enzyme inhibitors. A total of 666 patients died during a mean follow-up of 3.5 years. Of those patients, 56% were taking digoxin at their last follow-up visit.

After controlling for a number of variables, digoxin was found to be associated with higher all-cause, cardiovascular, and arrhythmic mortality. Heart failure status appeared to be immaterial: digoxin use was associated with higher all-cause mortality in patients with congestive heart failure (41% higher), those without (37% higher), and those with indeterminate heart failure status (64% higher).

The data also showed no relationship between sex and all-cause mortality. And comparing data on patients who died and received digoxin with data on those who didn't, "cardiac death with no evidence of [ischemia] was a significantly more frequent case of death" in the digoxin group.

The authors were unable to analyze dose relationships or serum levels in relationship to digoxin intake and mortality; however, the data clearly showed increased mortality with the use of digoxin among patients with AF. The authors conclude that the administration of digoxin in these patients should be reassessed, particularly considering the widespread use of this drug in this population.

Reference