Systematic review and meta-analysis of mortality and digoxin use in atrial fibrillation
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Key result
Digoxin in AF is linked to ~27% higher all-cause mortality vs. non-use.
- HR 1.27
- 95% CI 1.19-1.36
- P<0.001
- n=501,681
Why the study?
There is growing controversy regarding the association between digoxin use and mortality risk in patients with atrial fibrillation.
Does digoxin use increase mortality in patients with atrial fibrillation?
Comparison
Digoxin users vs non-digoxin users
Design
Systematic review and meta-analysis
Authors
Discussion
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Implication
May warrant caution with digoxin for rate control in AF; leaves open whether RCTs would confirm excess mortality.
Study Design
Type
Meta-Analysis (n=501,681)
Structured PICO
Does digoxin use increase mortality in patients with atrial fibrillation?
P
Population
501,681 patients with atrial fibrillation from 16 studies, including 111,978 digoxin users and 389,643 non-users, were included in a meta-analysis to evaluate the association between digoxin use and mortality.
E
Exposure
Digoxin use
C
Comparator
Non-digoxin use
O
Outcome
All-cause mortalityhard clinical
Main Result
Hazard Ratio: 1.27 (95% CI 1.19–1.36)
p-value: p=<0.001
In patients with atrial fibrillation, digoxin use is associated with a significantly increased risk of all-cause and cardiovascular mortality, with a stronger association in those without heart failure.
Limitations
- Lack of access to source data for the included studies
- Significant unexplained heterogeneity in the study populations
- Included clinical trial data were based on post hoc analyses, potentially introducing bias
- Potential for bias by indication
- Inability to assess the specific type of atrial fibrillation (e.g., paroxysmal, persistent, permanent)
- Exact doses of digoxin and other medications were unknown, limiting assessment of drug-drug interactions
Cite This Study
Qureshi et al. (2016) conducted a meta-analysis in Atrial fibrillation (n=501,681). Digoxin use vs. Non-digoxin users was evaluated on All-cause mortality (HR 1.27, 95% CI 1.19-1.36, p=<0.001). Digoxin use in patients with atrial fibrillation was associated with a 27% increased risk of all-cause mortality (HR 1.27) compared with non-users.
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