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The ATRIA-CVRN study: Digoxin associated with risk of death in adults with atrial fibrillation


Digoxin remains commonly used for rate control in atrial fibrillation, but very limited data exist supporting this practice and some studies have shown an association with adverse outcomes.
Researchers have examined the independent association between Digoxin and risks of death and hospitalization in adults with incident atrial fibrillation and no heart failure.

A retrospective cohort study of 14,787 age, gender and high-dimensional propensity score-matched adults with incident atrial fibrillation and no prior heart failure or Digoxin use in the AnTicoagulation and Risk factors In Atrial fibrillation-Cardiovascular Research Network ( ATRIA-CVRN ) Study within Kaiser Permanente Northern and Southern California, was performed.

Researchers have examined the independent association between newly initiated Digoxin and the risks of death and hospitalization using extended Cox regression.

During a median 1.17 ( interquartile range 0.49-1.97 ) years of follow-up among matched patients with atrial fibrillation, incident Digoxin use was associated with higher rates of death ( 8.3 vs 4.9 per 100 person-years, P less than 0.001 ) and hospitalization ( 60.1 vs 37.2 per 100 person-years, P less than 0.001 ).

Incident Digoxin use was independently associated with a 71% higher risk of death ( hazard ratio [ HR ] 1.71, 95% CI:1.52-1.93 ) and a 63% higher risk of hospitalization ( HR 1.63, 95% CI:1.56-1.71 ).

Results were consistent in subgroups of age and gender and when using intent-to-treat or on-treatment analytic approaches.

In conclusion, in adults with atrial fibrillation, Digoxin use was independently associated with higher risks of death and hospitalization.
Given other available rate control options, Digoxin should be used with caution in the management of atrial fibrillation. ( Xagena )

Freeman JV et al, Circ Arrhythm Electrophysiol 2014; Epub ahead of print

XagenaMedicine_2014



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