Key result
Digoxin-amiodarone combination therapy was associated with a significantly increased risk of all-cause mortality compared to digoxin alone in patients with atrial fibrillation (adjusted HR 1.640).
Why the study?
Combination use of digoxin and other medications might worsen outcomes in atrial fibrillation, prompting evaluation of whether digoxin-amiodarone leads to worse outcomes than digoxin alone.
Does digoxin-amiodarone combination therapy increase all-cause mortality in adult patients with atrial fibrillation compared to digoxin alone?
Cohort (n=4,133)
Does digoxin-amiodarone combination therapy increase all-cause mortality in adult patients with atrial fibrillation compared to digoxin alone?
Hazard Ratio: 1.64 (95% CI 1.47–1.829)
Absolute Event Rate: 37.3% vs 26.9%
p-value: p=<0.001
The combination of digoxin and amiodarone in patients with atrial fibrillation is associated with a significantly increased risk of all-cause mortality compared to digoxin alone.
Combination therapy may increase mortality risk in AF patients on digoxin; prospective trials needed to confirm association before changing practice.
Combination use of digoxin and other medications might lead to worse outcomes in patients with atrial fibrillation (AF). We sought to investigate whether digoxin-amiodarone combination would lead to worse outcome than digoxin alone in patients with AF. Adult patients with AF and received digoxin treatment from random samples of 1,000,000 individuals covered by the National Health Insurance in Taiwan were included. Baseline characteristics including risk factors and medications were matched by propensity score (PS) in those with and without addition of amiodarone treatment. A total of 5,040 AF patients taking digoxin therapy was included. PS matching identified 1,473 patients receiving digoxin-amiodarone combination and 2,660 patients receiving digoxin with a median follow-up of 1,331 days. Digoxin-amiodarone combination was associated with increased all-cause mortality (adjusted hazard ratio (HR): 1.640, 95% confidence interval (CI): 1.470-1.829, P < 0.001). The risk of mortality increased regardless of duration of combination. Risk of sudden cardiac death was not increased in the combination group (HR: 1.304, 95% CI: 1.049-1.622, P = 0.017). Death due to non-arrhythmic cardiac disease, cerebrovascular disease, and other vascular disease were higher in the combination group than the digoxin group. In conclusion, in patients with AF, digoxin-amiodarone combination therapy is associated with excess mortality than digoxin alone.
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Chiang et al. (2020) conducted a cohort in Atrial fibrillation (n=4,133). Digoxin-amiodarone combination vs. Digoxin alone was evaluated on All-cause mortality (HR 1.640, 95% CI 1.470-1.829, p=<0.001). Digoxin-amiodarone combination therapy was associated with a significantly increased risk of all-cause mortality compared to digoxin alone in patients with atrial fibrillation (adjusted HR 1.640).
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