Digoxin Raises Death Risk in Atrial Fibrillation Patients

A recent Kaiser Permanente study suggests digoxin is associated with a 71% increased risk of death and a 63% higher risk of hospitalization among adults diagnosed with atrial fibrillation who have no evidence of heart failure.

Current practice guidelines for atrial fibrillation management recommend using digoxin for resting heart-rate control in sedentary individuals. However, the study authors argued that limited data support using digoxin for rate control in atrial fibrillation patients, and most of the data have not assessed the drug’s long-term effects on mortality or hospitalization.

“Our findings suggest that the use of digoxin should be re-evaluated for the treatment of atrial fibrillation in contemporary clinical practice,” said Anthony Steimle, MD, chief of cardiology at Kaiser Permanente Santa Clara Medical Center, in a press release. “Given the other options available for heart-rate control, digoxin should be used with caution in the management of atrial fibrillation, especially in the absence of symptomatic systolic heart failure.”

The study involved approximately 15,000 adults from Kaiser Permanente’s northern and southern California regions who were diagnosed with atrial fibrillation between January 1, 2006, and June 30, 2009. The participants had recently been diagnosed with the condition and had no prior heart failure or digoxin use.

During the study period, 17.8% of participants began using digoxin, and 1140 participants in the total cohort died. The rate of death for digoxin users was significantly higher than non-users. Furthermore, there were 8456 hospitalizations for any cause, with a higher rate of hospitalization among those receiving digoxin.

The study was published in the current online issue of Circulation: Arrhythmia and Electrophysiology. It echoes the findings of an August 11, 2014, study that appeared in the Journal of the American College of Cardiology, in which Stanford University School of Medicine researchers found an increased risk of death in patients with newly diagnosed atrial fibrillation who received digoxin.

“This study included the largest and most diverse sample of adults with incident atrial fibrillation not complicated by heart failure treated in clinical practice reported to date, with results that were consistent across age and gender,” said lAlan S. Go, MD, research scientist at Kaiser Permanente’s Division of Research and lead author of the present study. “We believe these findings, which build on earlier work, have significant value in guiding clinical cardiology decision-making in regard to digoxin use in the modern era.”