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Re-analysis of digoxin data yields conflicting results

By News team

Debate continues over the use of digoxin in atrial fibrillation (AF). A recent suggestion that the drug’s use should be reassessed because of safety concerns is not supported by a further analysis of the same study data published online in the European Heart Journal (16 April 2013).

Last year, a post-hoc analysis of the 2002 "AF follow-up investigation of rhythm management" (AFFIRM) trial suggested that digoxin was associated with increased all-cause mortality (PJ 2012;289:654).

The latest analysis found no evidence of this. The technique of propensity-matched analysis was used to determine whether the reported association with higher mortality reflected an intrinsic adverse effect of digoxin or bias by indication (with, for example, a higher prevalence of heart failure in patients taking digoxin).

The researchers identified a cohort of around 900 pairs of patients receiving and not receiving digoxin who were balanced on key baseline characteristics. Among these matched patients, digoxin had no association with all-cause mortality (hazard ratio associated with digoxin use 1.06; 95 per cent confidence interval 0.83-1.37; P=0.64). There was also no association with all-cause admission to hospital.

The researchers say that the current analysis suggests no evidence to question the use of digoxin in AF and that the drug may be an attractive choice, especially for patients with relative contraindications to other rate-control drugs.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11120504

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