Digoxin use after myocardial infarction in patients with atrial fibrillation was associated with a higher 10-year all-cause mortality (77.4% vs 72.3%, HR 1.19) compared to no digoxin therapy.
Cohort (n=4,779)
Yes
Does digoxin use affect mortality and cardiovascular outcomes in patients with atrial fibrillation after myocardial infarction?
Digoxin use for atrial fibrillation after myocardial infarction is associated with increased long-term mortality, suggesting it should be used with caution, particularly in patients without heart failure.
Effect estimate: HR 1.19 (95% CI 1.07-1.32)
Absolute Event Rate: 77.4% vs 72.3%
p-value: p=0.001
Digoxin is used for rate control in atrial fibrillation (AF), but evidence for its efficacy and safety after myocardial infarction (MI) is scarce and mixed. We studied post-MI digoxin use effects on AF patient outcomes in a nationwide registry follow-up study in Finland. Digoxin was used by 18.6% of AF patients after MI, with a decreasing usage trend during 2004-2014. Baseline differences in digoxin users (n = 881) and controls (n = 3898) were balanced with inverse probability of treatment weight adjustment. The median follow-up was 7.4 years. Patients using digoxin after MI had a higher cumulative all-cause mortality (77.4% vs. 72.3%; hazard ratio HR: 1.19; confidence interval CI: 1.07-1.32; p = 0.001) during a 10-year follow-up. Mortality differences were detected in a subgroup analysis of patients without baseline heart failure (HF) (HR: 1.23; p = 0.019) but not in patients with baseline HF (HR: 1.05; p = 0.413). Cumulative incidences of HF hospitalizations, stroke and new MI were similar between digoxin group and controls. In conclusion, digoxin use after MI is associated with increased mortality but not with HF hospitalizations, new MI or stroke in AF patients. Increased mortality was detected in patients without baseline HF. Results suggest caution with digoxin after MI in AF patients, especially in the absence of HF.
Kytö et al. (Thu,) conducted a cohort in Atrial fibrillation after myocardial infarction (n=4,779). Digoxin vs. No digoxin therapy was evaluated on All-cause mortality (HR 1.19, 95% CI 1.07-1.32, p=0.001). Digoxin use after myocardial infarction in patients with atrial fibrillation was associated with a higher 10-year all-cause mortality (77.4% vs 72.3%, HR 1.19) compared to no digoxin therapy.