Digoxin is still commonly used in
atrial fibrillation (AF) patients with and without
heart failure (HF) for heart rate control. Studies concerning the detrimental effects of
digoxin therapy in AF patients are inconsistent. This updated meta-analysis examined the association of
digoxin therapy with all-cause mortality in AF patients, stratified by heart function status. We included observational studies with multivariate-adjusted data on
digoxin and all-cause mortality in the analysis. The relative risks (RRs) of all-cause mortality were calculated and reported with 95% confidence intervals (95% CIs). Seventeen studies comprising 408,660 patients were included. Overall, in AF patients,
digoxin treatment was associated with a significant increase in all-cause mortality after multivariate-adjustment (RR = 1.22; 95% CI 1.15-1.30). When stratified by heart function status,
digoxin treatment was associated with a 14% increase in all-cause mortality in AF patients with HF (RR = 1.14, 95% CI 1.04-1.24), and a 36% increase in those without HF (RR = 1.36, 95% CI 1.18-1.56). The increased risk of all-cause mortality was significantly higher in AF patients without HF compared with those with HF (P for interaction = 0.04). This meta-analysis demonstrates that
digoxin therapy was associated with a significant increase in all-cause mortality in AF patients, especially in those without HF. Given other available options,
digoxin should be avoided as a first-line agent for heart rate control in AF patients.