Abstract 16889: Digoxin Use and Subsequent Outcomes Among Patients with and without Heart Failure in a Contemporary Atrial Fibrillation Cohort: Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)
Background: Cardiac glycosides, such as digoxin, are the oldest cardiac drugs still prescribed, but use for the treatment both atrial fibrillation (AF) and heart failure (HF) remains controversial.
Methods: Longitudinal patterns of digoxin use and its association with a variety of outcomes were assessed in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), a prospective outpatient registry conducted at 176 sites in the United Statues with enrollment from June 2010 to August 2011.
Results: Among 10,130 patients with AF and serial follow up every 6 months for up to 3 years, 2,373 (23.4%) were receiving digoxin at study enrollment (of whom 794 discontinued use in follow up), 681 (6.7%) were initiated on digoxin during follow up, and 7,076 (70.0%) were never prescribed digoxin. Following adjustment for other medication use, heart rate was 73.0 beats per minute among digoxin users and 71.6 among non-users (p < 0.0001). After adjustment for a wide range of patient factors, prevalent digoxin use at enrollment was not associated with subsequent quality of life scores, hospitalization, or survival; in contrast, incident digoxin use during follow up was strongly associated with subsequent death, both in those with and without HF (see Table).
Conclusions: Incident but not prevalent digoxin use was associated with decreased survival. Given such safety concerns for a commonly used medication, high-quality contemporary outcomes data for digoxin are needed, possibly from a pragmatic clinical trial.
Author Disclosures: L.A. Allen: Consultant/Advisory Board; Modest; J&J, Janssen, Amgen, Novartis. Employment; Significant; University of Colorado. Research Grant; Significant; NIH, NHLBI - K23, PCORI. G.C. Fonarow: None. D.N. Holmes: Research Grant; Significant; Johnson & Johnson. L.E. Thomas: Research Grant; Significant; Johnson & Johnson. L.N. Marzec: None. S.D. Pokorney: Research Grant; Modest; AstraZeneca, Boston Scientific, Gilead. Consultant/Advisory Board; Modest; Janssen Pharmaceuticals. B. Gersh: None. A.S. Go: None. E.M. Hylek: None. P.R. Kowey: None. K.W. Mahaffey: None. P. Chang: Employment; Significant; Johnson & Johnson. E.D. Peterson: Research Grant; Significant; Johnson & Johnson. J.P. Piccini: Research Grant; Significant; Johnson & Johnson.
- © 2014 by American Heart Association, Inc.