Meta-analysis confirms digoxin is major threat to AF, HF patients

Digoxin, a cardiac glycoside popularly sold under the brand name Lanoxin, poses a major threat to the heart health of atrial fibrillation (AF) and heart failure (HF) patients, according to a review published in the American Journal of Cardiology Oct. 4. Even without confounding conditions, the drug can raise an individual’s risk of all-cause mortality.

The review, spearheaded by Mate Vamos, MD, PhD, retrospectively analyzed data from dozens of trials involving digoxin to assess its safety in heart patients. Still, it’s far from the first time physicians have voiced concern about the medication.

“In 2015, three independent meta-analyses raised concerns about digoxin therapy being associated with an increased mortality risk in patients with atrial fibrillation and with heart failure,” Vamos, of University Hospital Frankfurt-Goethe University in Frankfurt, Germany, and co-authors wrote. “Although several other studies have been published since then fostering these safety issues, the most recent 2016 guidelines for AF still recommend this therapy as a class I indication.”

Vamos’ team conducted an updated analysis using studies published in the Medline and Cochrane databases before March 2018. All eligible studies—37 in total, comprising a combined 825,061 patients—reported on digoxin use in AF and HF sufferers.

In the full patient pool, digoxin use was linked to a 1.17-fold increased risk of all-cause mortality, according to Vamos et al.’s results. That number remained steady in subgroup analyses—AF patients saw a 1.23-fold increased risk of death with digoxin use, and HF patients saw a 1.11-fold increased risk.

The authors also conducted a sensitivity analysis of studies of new digoxin users, which found 41,000 patients were at an even higher risk for all-cause death than those who had been using the drug long-term. New users were at a 1.47-fold increased risk of all-cause mortality.

“The present comprehensive meta-analysis confirmed that digoxin use is associated with an increased mortality risk in AF and HF patients treated according to contemporary guidelines,” Vamos and colleagues wrote. “Until results of randomized, placebo-controlled studies become available, digoxin should be used with great caution.”