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

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