ACC Report 2015: Digoxin treatment for atrial fibrillation tied to higher mortality

by Bruce Sylvester: Atrial fibrillation patients treated with digoxin have a 27 percent greater risk of dying than atrial fibrillation patients not treated with the drug, according to a new meta-analysis of 19 studies which included data on over 500,000 subjects.

The findings were presented on March 14, 2015 at the American College of Cardiology’s 64th Annual Scientific Session.

“The association we found based on the results of 19 studies was very strong,” said lead investigator Waqas Qureshi, M.D., a clinical and research fellow of cardiology at Wake Forest School of Medicine in Winston-Salem, North Carolina. “Until further research can be done, I would suggest physicians use caution when prescribing digoxin for patients with atrial fibrillation, especially given that there are alternative drugs available that might be safer.”

The authors noted that subjects with atrial fibrillation and kidney failure who used digoxin appeared to have an even higher risk, a 60 to 70 percent increase in mortality, compared to similar subjects not using the drug.

Current US guidelines recommend digoxin as a first-line or primary drug for atrial fibrillation in patients who are not physically active and as a second-line or alternative drug for patients who are more active.

The researchers accessed seven major research databases and identified studies involving atrial fibrillation that tracked mortality rates. They found 19 relevant studies published from 1960-2014, enrolling more than 500,000 subjects;  458,311 out of 501,681 subjects had atrial fibrillation. Digoxin was prescribed for 111,978 of the subjects.

The investigators reported that subjects with atrial fibrillation treated with digoxin were 27 percent more likely to die overall and 21 percent more likely to die from a cardiovascular cause than atrial fibrillation, compared to subjects not treated with digoxin.

“Based on consistent results coming out of many studies, our results suggest digoxin should be downgraded from its position as a front-line agent for certain patients with atrial fibrillation,” Qureshi said. “The study points to the need for a well-structured, targeted trial to investigate digoxin’s safety,” he added.