Details

Autor(en) / Beteiligte

• Allen, Larry A., MD, MHS
• Fonarow, Gregg C., MD
• Simon, DaJuanicia N., MS
• Thomas, Laine E., PhD
• Marzec, Lucas N., MD
• Pokorney, Sean D., MD, MBA
• Gersh, Bernard J., MB, ChB, DPhil
• Go, Alan S., MD
• Hylek, Elaine M., MD, MPH
• Kowey, Peter R., MD
• Mahaffey, Kenneth W., MD
• Chang, Paul, MD
• Peterson, Eric D., MD, MPH
• Piccini, Jonathan P., MD, MHS

Titel

Digoxin Use and Subsequent Outcomes Among Patients in a Contemporary Atrial Fibrillation Cohort

Ist Teil von

• Journal of the American College of Cardiology, 2015-06, Vol.65 (25), p.2691-2698

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background Although digoxin has long been used to treat atrial fibrillation (AF) and heart failure (HF), its safety remains controversial. Objectives This study sought to describe digoxin use over time in patients with AF who were stratified by the presence or absence of HF, to characterize the predictors of digoxin use and initiation, and to correlate digoxin use with outcomes. Methods Longitudinal patterns of digoxin use and its association with a variety of outcomes were assessed in a prospective outpatient registry conducted at 174 U.S. sites with enrollment from June 2010 to August 2011. Results Among 9,619 patients with AF and serial follow-up every 6 months for up to 3 years, 2,267 (23.6%) received digoxin at study enrollment, 681 (7.1%) were initiated on digoxin during follow-up, and 6,671 (69.4%) were never prescribed digoxin. After adjusting for other medications, heart rate was 72.9 beats/min among digoxin users and 71.5 beats/min among nonusers (p < 0.0001). Prevalent digoxin use at registry enrollment was not associated with subsequent onset of symptoms, hospitalization, or mortality (in patients with HF, adjusted hazard ratio [HR] for death: 1.04; without HF, HR: 1.22). Incident digoxin use during follow-up was not associated with subsequent death in patients with HF (propensity adjusted HR: 1.05), but was associated with subsequent death in those without HF (propensity adjusted HR: 1.99). Conclusions After adjustment for detailed clinical factors, digoxin use in registry patients with AF had a neutral association with outcomes under most circumstances. Because of the multiple conflicting observational reports about digoxin’s safety and possible concerns in specific clinical situations, a large pragmatic trial of digoxin therapy in AF is needed.