Daniele Pastori1, Alessio Farcomeni2, Tommaso Bucci1, Roberto Cangemi1, Paolo Ciacci1, Tommasa Vicario1, Francesco Violi1, Pasquale Pignatelli3. 1. I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinico of Rome, Italy. 2. Department of Public Health and Infectious Diseases, Statistics Section, Sapienza University of Rome, Italy. 3. I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinico of Rome, Italy. Electronic address: pasquale.pignatelli@uniroma1.it.
Abstract
BACKGROUND: Some evidences suggest that the use of digoxin may be harmful inatrial fibrillation (AF) patients. The aim of the study was to investigate in a "real world" of AF patients receiving vitamin K antagonists (VKAs), the relationship between digoxin use and mortality. METHODS: Prospective single-center observational study including 815 consecutive non-valvular AF patients treated with VKAs. Total mortality was the primary outcome of the study. We also performed a sub-analysis considering only cardiovascular (CV) deaths. Time in therapeutic range (TTR) was used for anticoagulation quality. RESULTS: Median follow-up was 33.2months (2460 person-years); 171 (21.0%) patients were taking digoxin. Compared to those without, patients on digoxin were older (p=0.007), with a clinical history of HF (p<0.001) and at higher risk of thromboembolic events (p<0.001). No difference in TTR between the two groups was registered (p=0.598). During the follow-up, 85 deaths occurred: 47 CV and 38 non-CV deaths; 35 deaths occurred in digoxin users (20.6%). A significant increased rate of total mortality was observed in digoxin-treated patients (p<0.001). Multivariable analysis showed that digoxin was associated with total mortality (hazard ratio [HR]: 2.224, p<0.001) and CV death (HR: 4.686, p<0.001). A propensity score-matched analysis confirmed that digoxin was associated with total mortality (HR: 2.073, p=0.0263) and CV death (HR: 4.043, p=0.004). CONCLUSIONS: In AF patients on good anticoagulation control with VKAs, digoxin use was associated with a higher rate of total and CV mortality.
BACKGROUND: Some evidences suggest that the use of digoxin may be harmful inatrial fibrillation (AF) patients. The aim of the study was to investigate in a "real world" of AFpatients receiving vitamin K antagonists (VKAs), the relationship between digoxin use and mortality. METHODS: Prospective single-center observational study including 815 consecutive non-valvular AFpatients treated with VKAs. Total mortality was the primary outcome of the study. We also performed a sub-analysis considering only cardiovascular (CV) deaths. Time in therapeutic range (TTR) was used for anticoagulation quality. RESULTS: Median follow-up was 33.2months (2460 person-years); 171 (21.0%) patients were taking digoxin. Compared to those without, patients on digoxin were older (p=0.007), with a clinical history of HF (p<0.001) and at higher risk of thromboembolic events (p<0.001). No difference in TTR between the two groups was registered (p=0.598). During the follow-up, 85 deaths occurred: 47 CV and 38 non-CV deaths; 35 deaths occurred in digoxin users (20.6%). A significant increased rate of total mortality was observed in digoxin-treated patients (p<0.001). Multivariable analysis showed that digoxin was associated with total mortality (hazard ratio [HR]: 2.224, p<0.001) and CV death (HR: 4.686, p<0.001). A propensity score-matched analysis confirmed that digoxin was associated with total mortality (HR: 2.073, p=0.0263) and CV death (HR: 4.043, p=0.004). CONCLUSIONS: In AFpatients on good anticoagulation control with VKAs, digoxin use was associated with a higher rate of total and CV mortality.
Authors: Kieran L Quinn; Erin M Macdonald; Tara Gomes; Muhammad M Mamdani; Anjie Huang; David N Juurlink Journal: Drug Saf Date: 2017-09 Impact factor: 5.606
Authors: Surbhi Chamaria; Anand M Desai; Pratap C Reddy; Brian Olshansky; Paari Dominic Journal: Cardiol Res Pract Date: 2015-12-14 Impact factor: 1.866
Authors: Oliver J Ziff; Deirdre A Lane; Monica Samra; Michael Griffith; Paulus Kirchhof; Gregory Y H Lip; Richard P Steeds; Jonathan Townend; Dipak Kotecha Journal: BMJ Date: 2015-08-30