Abstract 12709: Digoxin Use is Associated With an Increased Risk of Stroke in Patients With Atrial Fibrillation a Population-Based Cohort Study
Background: Atrial fibrillation (AF) is an independent risk factor for stroke. Digoxin use in patients with AF has been associated with increased levels of endothelial and platelet activation. Thus, it is possible that use of digoxin may increase the risk of stroke in AF patients. We investigated the incidence of first stroke among AF patients with and without digoxin use based on the insurance reimbursement claims in Taiwan.
Methods: We collected 13,480 patients from the registry of National Health Research Insurance database with first diagnosed AF during 1998-2009. We excluded 7,158 subjects with prior histories of stroke, pulmonary embolism, infective endocarditis or venous thrombosis before enrollment. Finally, 6,322 subjects were enrolled and divided into digoxin group and non-digoxin group. The end-point is the date of first diagnosed stroke or the last date of follow-up until December 31, 2009.
Results: Among the selected 6,322 patients, 57.1% received digoxin treatment. Use of digoxin was significantly associated with an increased risk of stroke (hazard ratio, 1.45; 95% confidence interval, 1.17 - 1.79) by Cox proportion regression analysis (Table 1). The Kaplan-Meier survival analysis reveals that use of digoxin increases 6% stroke incidence (p<0.0001) (Figure 1), compared to the non-digoxin group.
Conclusions: This large-scaled, population-based study shows that digoxin use in patients with AF is significantly associated with an increased risk of stroke. Further studies are necessary to delineate the exact mechanisms involved.
- © 2011 by American Heart Association, Inc.