There is conflicting evidence about whether Digoxin, might contribute to an increase in deaths in patients with atrial fibrillation ( AF ) or congestive heart failure ( CHF ).
Now, the largest review of all the evidence to date shows that it is associated with an increased risk of death in these patients, particularly in those being treated for atrial fibrillation.
In a study published in the European Heart Journal, researchers from the J.W. Goethe University in Frankfurt, Germany, conducted a systematic review and meta-analysis of all studies published in peer-reviewed journals between 1993-2014 that looked at the effects of Digoxin on death from any cause in atrial fibrillation and congestive heart failure patients.
Researchers identified 19 relevant studies that included a total of 326,426 patients ( 235,047 atrial fibrillation and 91,379 congestive heart failure patients ).
They found that Digoxin was associated with a 29% increased mortality risk in patients with atrial fibrillation and a 14% increased risk of death in congestive heart failure from any cause, when compared to patients not receiving the drug.
According to Authors, definite evidence can only come from results of randomised controlled trials. However, next to these, carefully performed meta-analyses provide the best clinical guidance and serve to generate hypotheses that need to be tested prospectively.
The analysis, together with evidence from other studies, all point in the same direction: there is harm associated with the use of Digoxin.
There has only been one prospective randomised controlled trial of Digoxin, which was carried out in 6,800 patients with congestive heart failure, and none in patients with atrial fibrillation. ( Xagena )
Source: European Society of Cardiology, 2015