Introduction: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is a significant risk factor for ischemic stroke and death. Digitalis has been used for more than 200 years to treat heart conditions, including AF, and its use remains controversial due to uncertain long-term morbidity and mortality.
Methods: We conducted a cohort study of hospitalized patients with AF assessing the effects of digoxin on long-term all-cause mortality. Patients were divided into two groups: with and without heart failure (HF). We performed multivariable Cox regression analysis to assess hazard ratios (HR) for all-cause mortality depending on digoxin treatment and used propensity score matching to adjust for differences in background characteristics between treatment groups.
Results: Among 2179 consecutive patients hospitalized with AF, the median age was 73 ± 14, and 52.5% of patients were male, 49% had HF, and 18.8% were discharged on digoxin. Median left ventricular ejection fraction in the whole cohort was 60 (IQR 40-65). Among patients with HF, 34.5% had preserved, 17.3% had mid-range and 48.1% had reduced left ventricular ejection fraction. The mean follow-up time was 3 ± 2.05 years. In patients without HF there was a statistically significant increased mortality in the digoxin subgroup after propensity score matching (HR = 2.23, 95% CI 1.42-3.51, p < 0.001). In contrast, in patients with HF, there was no difference in mortality between the treatment groups (p = 0.92).
Conclusions: Digoxin use in our study was associated with increased mortality in patients with AF and without concomitant HF.
Differential effect of left ventricular ejection fraction on long term mortality in patients hospitalized with acute heart failure. Data from the HFSIS 2003 registry
