Why the study?
Studies linking therapeutic digoxin use with increased mortality have potential biases, and randomized controlled trials evaluating mortality in AF are lacking despite widespread continued use.
Does digoxin increase mortality in patients with atrial fibrillation?
Does digoxin increase mortality in patients with atrial fibrillation?
Despite widespread use for AF, digoxin's safety regarding mortality remains uncertain due to a lack of dedicated RCTs, warranting careful prescription and rigorous serum level monitoring.
Answers are grounded in this paper and cite their sources.
Digoxin safety in AF remains unresolved by observational data; leaves open need for RCTs to guide use.
Digoxin has been used for more than 50 years in patients with Atrial Fibrillation (AF), with the goal of Controlling Heart Rate (HR) and restoring sinus rhythm. In the last two decades, several studies have correlated therapeutic use of digoxin with increased mortality. However, such studies have potential biases that cannot be disregarded, mainly because they are cross-sectional experiments or post-hoc analyses of Randomized Controlled Trials (RCTs). Despite uncertainties regarding the safety of digoxin in this setting, it remains one of the most prescribed drugs for AF worldwide. On the other hand, the absence of any RCTs designed to evaluate mortality makes a definitive conclusion more difficult to reach; therefore, this medication must be used with care. In this review, we explored the therapeutic use of digoxin in the context of AF, discussed mortality data by means of critical analysis in the light of the best available evidence, and position ourselves in relation to more rigorous control of serum levels of this drug in daily practice.
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Ferrari et al. (2019) studied this question.
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