FROM ACC 2015
SAN DIEGO (FRONTLINE MEDICAL NEWS) – Digoxin increases the risk of death by 27% in patients with atrial fibrillation, a meta-analysis of 19 studies showed.
Patients with AF and kidney failure faced a 60% to 70 % increase in mortality compared to their counterparts not taking digoxin, according to a press release on the study.
A weaker association between digoxin and death was observed in AF patients who also had heart failure, a finding the authors suggest warrants further investigation.
“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,” lead author Dr. Waqas Qureshi said in a statement.
The results were released in advance of their March 15 presentation at the annual meeting of the American College of Cardiology in San Diego.
About 5.6 million Americans have atrial fibrillation (AF) and roughly 1 in 5 are prescribed digoxin for heart rate control.
Current guidelines recommend digoxin as first-line therapy in patients who aren’t physically active and as a second-line drug for more active patients.
“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,” Dr. Qureshi , a clinical and research cardiology fellow at Wake Forest School of Medicine in Winston-Salem, N.C., recommended.
The authors reviewed 19 studies including five cohort and randomized controlled trials involving 501,681 patients. Of these, 458,311 patients had AF and 111,978 were prescribed digoxin.
In a random effects model, digoxin was associated with an increased risk of mortality, with a pooled hazard ratio of 1.27 (95% confidence interval 1.19-1.36; P value < .001).
Several studies in the meta-analysis suggest that higher blood levels of digoxin increase the risk of death. The mechanism behind the increased mortality is not known, although previous studies have suggested digoxin increases the risk of thromboembolism.
The meta-analysis accounted for risk factors and co-morbidities reported in the various studies, but it’s possible that some confounding factors may not have been accounted for, the authors acknowledge.
“The study points to the need for a well-structured, targeted trial to investigate digoxin’s safety,” Dr. Qureshi stated.