Digoxin is one of the oldest drugs in the cardiovascular arsenal, derived from the foxglove plant and initial described in the 18th century by William Withering. It is often employed in individuals with heart failure (HF) and with atrial fibrillation (AF). The few trials supporting its use have been performed in HF individuals before newer treatments arrived. There have been no good trials in AF.
A new observational examine published in the Journal of the American College of Cardiology now supplies the most comprehensive perspective on digoxin use in AF. Researchers examined information on a lot more than 122,000 individuals in the Veterans Affairs method who had newly diagnosed AF. During 350,000 patient-years of comply with-up, approximately 1-quarter of the sufferers died. Virtually 29,000 patients who acquired digoxin had been matched with an equal number of controls who did not. The risk for death was larger amid digoxin recipients than controls — a locating that remained significant right after multivariable adjustment (hazard ratio, one.21).
- Unadjusted hazard ratio for digoxin sufferers: one.37 (CI one.33-1.40, p<0.001)
- Multivariate adjustment: 1.26 (CI 1.23-one.29, p<0.001)
The authors acknowledged the limitations of observational studies but explained that their sensitivity analyses recommended that any effect of unmeasured confounders would not likely have resulted in a main modify in the findings.
Responding to a question from the editors of CardioExchange, the lead author of the review, Mintu Turakhia, suggested that clinicians use digoxin sparingly: ”in light of the a lot of other medication that can be employed for charge control, clinicians need to ask whether or not digoxin ought to be the therapy of option for the patient in front of them when there are other, safer options.”
In an accompanying editorial, Matthew Reynolds praises the study but argues that since digoxin for AF is more most likely to be utilised in larger danger HF sufferers the “true” hazard ratio is probably to be reduced than reported. Offered the substantial charge of adverse events brought on by the drug, he suggests that digoxin ought to only be employed “selectively and with care in AF individuals.” But, he concludes, “for now, there are nevertheless clinical conditions (HF, tough fee control, lower blood stress) in which this previous herbal treatment remains useful.”
Harlan Krumholz said that “this review raises considerations about the safety of digoxin in the remedy of patients with AF. Offered the range of medications available, any use of digoxin in this setting need to demand specific justification indicating why the advantages outweigh the possible dangers. It’s time to pause on digoxin till research can assure that it is providing a net benefit to these sufferers.”
J Am Coll Cardiol. 2014 64(7): 660-668.
Review Provides Tiny Support for an Previous Drug
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