Effect of Digoxin Therapy on Patients with Atrial Fibrillation - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

JaYanah Morad Clinical Research Center, Soroka University Medical Center, Beersheva, Israel Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel Ksynea Epstein Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel Iftach Sagy Clinical Research Center, Soroka University Medical Center, Beersheva, Israel Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel Victor Novack Clinical Research Center, Soroka University Medical Center, Beersheva, Israel Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel Moti Haim Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel Electrophysiology and Pacemakers Unit, Soroka University Medical Center, Beersheva, Israel

Background

Digoxin has long been used for rate control in atrial fibrillation (AF), although due to conflicting results its safety remains unclear

Objective

To evaluate the association of digoxin use among hospitalized patients with atrial fibrillation and their outcome

Methods

we conducted a population based retrospective cohort study including all patients hospitalized in SUMC during 2005-2017 with with atrial fibrillation as a primary admission diagnosis (n=3600).We conducted an interrupted time series propensity score matched analysis for digoxin exposure within the first year after index hospitalization. We calculated the risk for all-cause mortality, stroke, Myocardial infarction (MI), re-hospitalization, and composite outcome within the first year after index hospitalization. The mean follow-up time was 1 year

Results

We included 1505 patients with AF as primary diagnosis, of whom 425 patients received dixogin.(mean age 73.02±11, 62.6% female) Mortality rate among digoxin users was 17% vs 9% among non-users(P <0.001). However, digoxin use was not associated with higher mortality risk after multivariate adjustment (HR: 0.82, 95%CI: 0.44-1.5, P=0.52) and propensity matching (HR: 0.95, 95%CI: 0.6-1.53, P=0.85).

After multivariate adjustment and propensity matching Digoxin use was associated with higher risk of stroke (HR: 2.5 , 95% CI1.2-5.3:, P=0.013) -MI ( (HR:2.02, 95% CI:1.03-3.9, P=0.042), re-hospitalization (HR:1.8, 95% CI1.5-2.1:, P<0.001), and overall higher composite adverse outcome:1.58, 95% CI:1.3-1.9, P<0.001).

Conclusion:

Digoxin usage was associated with higher risk of stroke, MI and re-hospitalization but not with increased risk of mortality during a follow-up period of 1 years