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  1. Kam Uppell
  1. Correspondence to Kam Uppell, London WC1H 9JR, UK; kuppell{at}

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Digoxin use and increased mortality in patients with AF

Digoxin is associated with a significant increase in all-cause mortality in patients with atrial fibrillation (AF), according to a study published in the European Heart Journal. Researchers analysed data from patients enrolled in the AF Follow-up Investigation of Rhythm Management (AFFIRM) trial. The AFFIRM trial had enrolled 4060 patients with AF considered at high risk for stroke. The researchers used multivariate Cox proportional hazards models to assess the impact of digoxin as a time-dependent covariate on all-cause mortality, cardiovascular mortality and arrhythmic cardiovascular mortality. Analyses were conducted in all patients and in subsets according to the presence or absence of heart failure (HF).

The findings showed that digoxin was associated with an increase in all-cause mortality (estimated HR (EHR) 1.41, 95% CI 1.19 to 1.67, p<0.001), cardiovascular mortality (EHR 1.35, 95% CI 1.06 to 1.71, p=0.016) and arrhythmic mortality (EHR 1.61, 95% CI 1.12 to 2.30, p=0.009). ‘The all-cause mortality was increased with digoxin in patients without or with HF. There was also no significant digoxin-gender interaction for all-cause (p=0.70) or cardiovascular (p=0.95) mortality’, say the researchers. ‘Our findings suggest that, in patients with AF, digoxin is associated with increased all-cause mortality after controlling for comorbidities and propensity scores, regardless of gender and the presence or absence of underlying HF’. All-cause mortality was 41% higher in patients on digoxin. The researchers stress that their findings underscore the importance of reassessing the role of digoxin in the management of AF in patients with or without HF.

Eur Heart J doi:10.1093/eurheartj/ehs348

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.