Atrial Fibrillation Patients Prescribed Digoxin Are More Likely to Die

Digoxin increases risk of death in patients with newly diagnosed atrial fibrillation.

In his account of the medical uses of foxgloves published in 1785, Sir William Withering cautioned that digoxin is not “the perfect drug” for atrial fibrillation. Now, more than 200 years later, Stanford University researchers have reissued his warning through their medical research.

In a study published online August 11, 2014 in the Journal of the American College of Cardiology, researchers at the Stanford University School of Medicine linked the digitalis derivative, digoxin, to increased risk of death in patients with newly diagnosed atrial fibrillation, a condition that results in a rapid or irregular heartbeat rhythm.

“The take-home point is to question whether people should really be on this drug,” said lead author, Mintu Turakhia, MD, assistant professor of cardiology at Stanford and director of cardiac electrophysiology at the US Department of Veterans Affairs (VA) Palo Alto Health Care System. “These data challenge the current guidelines.”

After examining 122,465 patients with atrial fibrillation in the VA system between 2003 and 2008, Turakhia and his research team discovered that those treated with digoxin were 1.2 more likely to die than those prescribed other forms of atrial fibrillation treatment.

“We are not asserting this drug should never be used,” Turakhia continued. “However, in light of the many other drugs that can be used to slow down the heart rate in atrial fibrillation, patients and providers need to ask whether digoxin should be the treatment of choice when there are other, safer drugs.”

Because the study’s participant pool was primarily male, Turakhia is calling for additional studies to determine whether the same adverse effects can be cited in women. However, he realized that further studies on the drug might be difficult to conduct, as drugs that have been approved and regularly used throughout history are typically not the subjects of studies conducted by pharmaceutical companies.

“This is going to be as close to proof positive as we get because we may never have a randomized trial of this drug,” Turakhia said.

In the past, digoxin has been able to slow down the heart rates of patients with atrial fibrillation; however, it does not bring the heart rate to a normal rhythm, which is necessary to correct the problem altogether.

The study authors concluded that more research is needed to determine exactly what digoxin does to the body to increase the risk of death in patients with newly diagnosed atrial fibrillation. In the meantime, they recommended that physicians consider alternatives to digoxin when working with atrial fibrillation patients.