Clinical outcomes in patients with atrial fibrillation treated with digoxin, according to the presence of heart failure: Insights from the MISOAC-AF trial

• Published in: Hellenic journal of cardiology 2022-11, Vol.68, p.25-32
• Main Authors: Botis, Michail, Kartas, Anastasios, Samaras, Athanasios, Akrivos, Evangelos, Vrana, Elena, Liampas, Evangelos, Papazoglou, Andreas S., Moysidis, Dimitrios V., Papanastasiou, Anastasios, Baroutidou, Amalia, Karvounis, Haralambos, Tzikas, Apostolos, Parissis, John, Drakos, Stavros G., Giannakoulas, George
• Format: Article
• Language: English
• Subjects: Atrial fibrillation; Death; Digitalis; Heart failure; Hospitalization; Mortality
• ISSN: 1109-9666; 2241-5955
• DOI: 10.1016/j.hjc.2022.08.001

Digoxin is widely used in atrial fibrillation (AF) and heart failure (HF). However, current evidence regarding its association with clinical outcomes is conflicting. To investigate the relationship between digoxin therapy and adverse outcomes in patients with AF, with or without HF, in a contemporary AF cohort. We performed a retrospective analysis of data from 698 patients, who were followed over a median of 2.5 years. The primary outcome was all-cause mortality and the secondary outcome was all-cause hospitalization, in a time-to-event analysis. Propensity scores were used to derive matched populations, balanced on key baseline covariates. To limit potential confounding, inverse probability of treatment weighting (IPTW) analysis was performed. Among patients with HF, 39 (10.5%) were administered digoxin at baseline, whereas 331 (89.5%) were not. Digoxin administration was not associated with an increased risk of death (hazard ratio (HR) in the digoxin group, 1.21; 95% Confidence Interval (CI), 0.69 to 2.13, p = 0.50) or hospitalization of any cause (HR 1.15; 95% CI, 0.67 to 1.96; p = 0.60). Among patients without HF, 11 (3.5%) were administered digoxin, with neutral effects on all-cause mortality (HR: 3.25; 95% CI, 0.98 to 10.70), p = 0.06) and all-cause hospitalization (HR, 1.15; 95% CI, 0.67 to 1.96, p = 0.60). Qualitatively, consistent results were observed using IPTW. Among patients with AF, digoxin administration was not associated with an increased risk of death and hospitalization for any cause, irrespective of HF status. [Display omitted]