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Digoxin is associated with an increased risk of death in atrial fibrillation patients

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The study

Meta-analysis of studies on MEDLINE and COCHRANE from 1993-2014 about the effects of digoxin on mortality in patients suffering from congestive heart failure (CHF) or atrial fibrillation (AF). One study was an RCT, and the others were retrospective or prospective observational studies. Some 19 studies with 326,426 patients were analysed.

Main findings

Among the 235,047 AF patients, those on digoxin had a 29% higher mortality risk than those not on digoxin.

Among the 91,379 CHF patients, digoxin was associated with a 14% increase in mortality risk.

Based on data from all 326, 426 patients in the 19 trials, the use of digoxin was associated with an increased relative risk of mortality of 21% (compared to patients not taking digoxin).

What this means for GPs

GPs should be very cautious when prescribing digoxin, and consider the potential for increase in mortality risk - especially in patients with AF.

It is also advisable to monitor plasma digoxin levels regularly.

The paper

European Heart Journal, May 2015

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Readers' comments (4)

  • Do many GPs initiate digoxin these days?

    I thought of it as an "old" rate-control treatment which some patients have been left on from the days when we used fewer beta-blockers for AF.

    Should we be stopping it for established patients?

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  • And there is no possibility that the ones on Digoxin were more ill and there has never ever been any evidence that they have an increased mortality from that of course.
    In other news; sun conclusively shown to set in the west, except on cloudy days when there is of course no evidence. Further study is required.

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  • @ 10.19. Exactly. What a waste of time.

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  • Another study has conclusively shown that having grey hair leads to a higher mortality.The Editorial stressed that we should all start dying our hair from reaching 30s onwards.

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Have your say

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