Predictors of digoxin use and risk of mortality in ED patients with atrial fibrillation.

Abstract

OBJECTIVES:

The aim of this study was to evaluate factors of digoxin use and its relation to mortality in ED patients with atrial fibrillation (AF).

METHODS:

The Chinese AF registry enrolled 2016 AF patients from 20 representative EDs, and the period of study was one year. Predictors of digoxin use and its relation to mortality were assessed by logistic and Cox regression analyses.

RESULTS:

Digoxin was assigned in 609 patients (30.6%), and younger age, lower body mass index values, and existence of permanent AF, heart failure (HF), chronic obstructive pulmonary disease, and valvular heart disease were identified to be factors associated with digoxin use. During the follow-up, compared to patients without digoxin therapy, digoxin-treated patients had significantly higher risk of all-cause death (17.2% vs. 13.0%, P=0.012) and cardiovascular death (15.1% vs. 6.7%, P<0.001), but similar risk of sudden cardiac death (1.1% vs. 0.7%, P=0.341). However, after adjustment for related covariates, digoxin use was no longer notably associated with increased all-cause mortality (hazards ratio [HR] 0.973, 95% confidence interval [CI] 0.718-1.318) and cardiovascular death (HR 1.313, 95% CI 0.905-1.906). Besides, neutral associations of digoxin treatment to mortality were obtained in relevant subgroups, with no interactions observed between digoxin and gender, HF, valvular heart disease, or concomitant warfarin treatment in mortality risk.

CONCLUSIONS:

In ED patients with AF, digoxin was more frequently assigned to vulnerable patients with concomitant HF or valvular heart disease, and digoxin use was not related to a significantly increased risk of mortality.

• Authors: Shuang Wu, Yan-Min Yang, Jun Zhu, Jia-Meng Ren, Juan Wang, Han Zhang, Xing-Hui Shao
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 35 Issue 11 Pg. 1589-1594 (Nov 2017) ISSN: 1532-8171 [Electronic] United States
• PMID: 28551087 (Publication Type: Journal Article)
• Copyright: Copyright © 2017. Published by Elsevier Inc.

Chemical References

• Anti-Arrhythmia Agents
• Allopurinol
• Digoxin

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Allopurinol
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (drug therapy, epidemiology)
• Body Mass Index
• Cardiovascular Diseases (mortality)
• Cause of Death
• China (epidemiology)
• Comorbidity
• Death, Sudden, Cardiac (epidemiology)
• Digoxin (therapeutic use)
• Emergency Service, Hospital
• Female
• Heart Failure (epidemiology)
• Heart Valve Diseases (epidemiology)
• Humans
• Male
• Middle Aged
• Mortality
• Proportional Hazards Models
• Prospective Studies
• Pulmonary Disease, Chronic Obstructive (epidemiology)
• Registries
• Risk Factors