Relation of digoxin use in atrial fibrillation and the risk of all-cause mortality in patients ≥65 years of age with versus without heart failure. Should digoxin be proscribed in elderly subjects in sinus rhythm free from heart failure? A population-based study. Digoxin in atrial fibrillation: report from the Stockholm Cohort study of Atrial Fibrillation (SCAF) Digoxin Use and Subsequent Outcomes Among Patients in a Contemporary Atrial Fibrillation Cohort. Lack of evidence of increased mortality among patients with atrial fibrillation taking digoxin: findings from post hoc propensity-matched analysis of the AFFIRM trial. Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study. Digoxin use and risk of mortality in hypertensive patients with atrial fibrillation Digoxin in patients with permanent atrial fibrillation: data from the RACE II study. Digoxin treatment is associated with increased total and cardiovascular mortality in anticoagulated patients with atrial fibrillation. Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure? Predictors, prevention, and long-term prognosis of atrial fibrillation after coronary artery bypass graft operations. Observational cohort study of the safety of digoxin use in women with heart failure Comparison Of Digoxin Versus Low‐Dose Amiodarone For Ventricular Rate Control In Patients With Chronic Atrial Fibrillation Digoxin Is Associated With Increased Shock Events and Electrical Storms in Patients With Implantable Cardioverter Defibrillators Mortality and morbidity of heart failure treated with digoxin. A propensity-matched study. Effect of concomitant digoxin and carvedilol therapy on mortality and morbidity in patients with chronic heart failure. A controlled trial of digoxin in congestive heart failure.
Previous studies on digoxin use in patients with atrial fibrillation ( AF ) and the risk of all-cause mortality  found conflicting results . We conducted a population -based , retrospective , cohort study of patients aged ≥65 years admitted to a hospital with a primary or secondary diagnosis of AF , in Quebec province , Canada , from 1998 to 2012 . The AF cohort was grouped into patients with and without heart failure ( HF ) and into  digoxin and no-digoxin users according to the first prescription filled for digoxin within 30 days after AF hospital discharge . We derived propensity score-matched digoxin and no-digoxin treatment groups for the groups of patients with and without HF , respectively , and conducted multivariable Cox proportional hazards regression analyses to determine association between digoxin use and all-cause mortality . The AF propensity score-matched cohorts of patients with and without HF were well balanced on baseline characteristics . In the propensity score-matched HF group , digoxin use was associated with a 14 % greater risk of all-cause mortality ( adjusted hazard ratio 1.14 , 95 % confidence interval 1.10 to 1.17 ) . In the propensity score-matched no-HF group , digoxin use was associated with a 17 % greater risk of all-cause mortality ( adjusted hazard ratio 1.17 , 95 % confidence interval 1.14 to 1.19 ) . In conclusion , our retrospective analyses found that digoxin use was associated with a greater risk for all-cause mortality in patients aged ≥65 years with AF regardless of concomitant HF . Large , multicenter , r and omized controlled trials or prospect i ve cohort studies are required to clarify this issue Increased mortality in digoxin-treated subjects has been demonstrated in patients with recent myocardial infa rct ion . Those with congestive heart failure ( CHF ) due to causes other than myocardial infa rct ion seem to be free from this effect . No information is currently available concerning mortality in elderly people who are frequently prescribed digitalis even in the absence of CHF . The aim of this study was to investigate whether subjects improperly receiving digoxin were worse off than those not receiving this drug . This analysis is a part of CASTEL , a population -based prospect i ve study that has enrolled a cohort of 2,254 subjects aged > or = 65 years . CHF was diagnosed in 187 subjects and atrial fibrillation ( AF ) in 90 . The remaining 1,977 were free from CHF and in sinus rhythm , but 447 were treated with digitalis .  Cumulative mortality and morbid events by digitalis treatment were calculated in all these categories . Among subjects free from CHF and AF ( improper use ) , all-cause and cardiovascular mortality was significantly higher among those taking digitalis than in those who did not . Non-fatal events including CHF were also more apparent in the former than in the latter . Cox analysis confirmed digitalis as a predictor of mortality in these subjects . No effect of digitalis on survival was found in patients with CHF or AF ( proper use ) . In elderly subjects without atrial fibrillation or CHF , the use of digitalis worsens morbidity and mortality Background Recent studies of patients with heart failure and of patients receiving intensive care indicate that digoxin may increase mortality if the patient has atrial fibrillation ( AF ) . Objective To study which patients receive  digoxin treatment for AF and what the prognosis is for patients given this treatment . Method 2824 patients with AF were studied prospect ively for a mean of 4.6 years . Information about medication was obtained from the local hospital registry . Information about diagnoses , hospitalisations and deaths was obtained from national registries . Propensity score matching and Cox regression was used to account for confounding . Results Factors associated with digoxin use were permanent AF ( hazard ratio ( HR ) = 3.2 , confidence interval ( CI ) 2.7 to 3.9 ) , absence of pacemaker ( HR = 2.3 , CI 1.6 to 3.2 ) , history of heart failure ( HR = 2.0 , CI 1.7 to 2.5 ) , treatment in an internal medicine ward rather than a cardiology ward ( HR = 1.6 , CI 1.3 to 2.0 ) , female sex ( HR = 1.6 , CI 1.3 to 1.9 ) and age ≥80 years ( HR = 1.4 , CI 1.1 to 1.7 ) . More patients with than without digoxin died ( 51 % vs 31 % , p<0.001 ) . After adjustment for covariates , however , no disadvantages related to digoxin use could be found for all-cause mortality , myocardial infa rct ion , ischaemic stroke , time to readmission to hospital or days at hospital/year at risk . The only end point significantly associated with digoxin use was pacemaker implantations , which were more common in digoxin-treated patients ( HR = 2.0 , CI 1.2 to 3.4 ) . Conclusion Digoxin is mainly given to an elderly and frailer subset of patients with AF and is thus associated with an increased mortality . When differences in patient characteristics are accounted for digoxin use seems to have a neutral effect on mortality and major cardiovascular events in patients with AF BACKGROUND Although digoxin has long been used to treat atrial fibrillation ( AF ) and heart failure ( HF ) , its safety remains controversial . OBJECTIVES This study sought to describe digoxin use over time in patients with AF who were stratified by the presence or absence of HF , to characterize the predictors of digoxin use and initiation , and to correlate digoxin use with outcomes . METHODS Longitudinal patterns of digoxin use and its association with a variety of outcomes were assessed in a prospect i ve outpatient registry conducted at 174 U.S. sites with enrollment from June 2010 to August 2011 . RESULTS Among 9,619 patients with AF and serial follow-up every 6 months for up to 3 years , 2,267 ( 23.6 % ) received digoxin at study enrollment , 681 ( 7.1 % ) were initiated on digoxin during follow-up , and 6,671 ( 69.4 % ) were never prescribed digoxin . After adjusting for other medications , heart rate was 72.9 beats/min among digoxin users and 71.5 beats/min among nonusers ( p < 0.0001 ) . Prevalent digoxin use at registry enrollment was not associated with subsequent onset of symptoms , hospitalization , or mortality ( in patients with HF , adjusted hazard ratio [ HR ] for death : 1.04 ; without HF , HR : 1.22 ) . Incident  digoxin  use during follow-up was not associated with subsequent death in patients with HF ( propensity adjusted HR : 1.05 ) , but was associated with subsequent death in those without HF ( propensity adjusted HR : 1.99 ) . CONCLUSIONS After adjustment for detailed clinical factors , digoxin use in registry patients with AF had a neutral association with outcomes under most circumstances . Because of the multiple conflicting observational reports about digoxin 's safety and possible concerns in specific clinical situations , a large pragmatic trial of digoxin therapy in AF is needed AIMS Digoxin is recommended for long-term rate control in paroxysmal , persistent , and permanent atrial fibrillation ( AF ) . While some analyses suggest an association of digoxin with a higher mortality in AF , the intrinsic nature of this association has not been examined in propensity-matched cohorts , which is the objective of the current study . METHODS AND RESULTS In Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) , 4060 patients with paroxysmal and persistent AF were r and omized to rate ( n = 2027 ) vs. rhythm ( n = 2033 ) control strategies . Of these , 1377 received digoxin as initial therapy and 1329 received no digoxin at baseline . Propensity scores for digoxin use were estimated for each of these 2706 patients and used to assemble a cohort of 878 pairs of patients receiving and not receiving digoxin , who were balanced on 59 baseline characteristics . Matched patients had a mean age of 70 years , 40 % were women , and 11 % non-white . During the 3.4 years of the mean follow-up , all-cause mortality occurred in 14 and 13 % of matched patients receiving and not receiving digoxin , respectively [ hazard ratio ( HR ) associated with digoxin use : 1.06 ; 95 % confidence interval ( CI ) : 0.83 - 1.37 ; P = 0.640 ] . Among matched patients , digoxin had no association with all-cause hospitalization ( HR : 0.96 ; 95 % CI : 0.85 - 1.09 ; P = 0.510 ) or incident non-fatal cardiac arrhythmias ( HR : 0.90 ; 95 % CI : 0.37 - 2.23 ; P = 0.827 ) . Digoxin had no multivariable-adjusted or propensity score-adjusted associations with these outcomes in the pre-match cohort . CONCLUSIONS In patients with paroxysmal and persistent AF , we found no evidence of increased mortality or hospitalization in those taking digoxin as baseline initial therapy INTRODUCTION AND OBJECTIVES We aim ed to assess and compare the effect of digoxin on clinical outcomes in patients with atrial fibrillation vs those under beta-blockers or none of these drugs . METHODS AFBAR is a prospect i ve registry study carried out by a team of primary care physicians ( n=777 patients ) . Primary endpoints were survival , survival free of admission due to any cause , and survival free of admission due to cardiovascular causes . The mean follow up was 2.9 years . Four groups were analyzed : patients receiving digoxin , beta-blockers , or digoxin plus beta-blockers , and patients receiving none of these drugs . RESULTS Overall , 212 patients ( 27.28 % ) received digoxin as the only heart control strategy , 184 received beta-blockers ( 23.68 % ) , 58 ( 7.46 % ) were administered both , and 323 ( 41.57 % ) received none of these drugs . Digoxin was not associated with all-cause mortality ( estimated hazard ratio=1.42 ; 95 % confidence interval , 0.77 - 2.60 ; P=.2 ) , admission due to any cause ( estimated hazard ratio=1.03 ; 95 % confidence interval , 0.710 - 1.498 ; P=.8 ) , or admission due to cardiovascular causes ( estimated hazard ratio=1.193 ; 95 % confidence interval , 0.725 - 1.965 ; P=.4 ) . No association was found between digoxin use and all-cause mortality , admission due to any cause , or admission due to cardiovascular causes in patients without heart failure . There was no interaction between digoxin use and sex in all-cause mortality or in survival free of admission due to any cause . However , an association was found between sex and admission due to cardiovascular causes . CONCLUSIONS Digoxin was not associated with increased all-cause mortality , survival free of admission due to any cause , or admission due to cardiovascular causes , regardless of underlying heart failure Background : Digoxin is widely used for rate control of atrial fibrillation . However , recent studies have reported conflicting results on the association of digoxin with mortality when used in patients with atrial fibrillation . Moreover , the relationship of digoxin use to mortality in hypertensive patients with atrial fibrillation has not been examined . Methods and results : All-cause mortality was examined in relation to in-treatment digoxin use in 937 hypertensive patients with ECG left ventricular hypertrophy in atrial fibrillation at baseline ( n = 134 ) or who developed atrial fibrillation during follow-up ( n = 803 ) , r and omly assigned to losartan or atenolol-based treatment , in post-hoc analysis of a sub study of the Losartan  Intervention For Endpoint Reduction in hypertension ( LIFE ) trial . During 4.7 ± 1.1 years of mean follow-up , 167 patients died ( 17.8 % ) and 372 ( 39.7 % ) were treated with digoxin . In univariate Cox analyses , in-treatment digoxin use , entered as a time-varying covariate , was associated with a 61 % higher risk of dying ( hazard ratio 1.61 , 95 % confidence interval 1.18–2.19 , P = 0.003 ) . After adjusting for other univariate predictors of death in this population , including age , diabetes , history of ischemic heart disease , stroke , or heart failure , baseline Cornell product , QRS duration , heart rate , serum glucose , creatinine and high-density lipoprotein cholesterol , and a propensity score for digoxin use entered as st and ard covariates , and for in-treatment heart rate , pulse pressure , and Sokolow – Lyon voltage treated as time-varying covariates , digoxin use was no longer a significant predictor of mortality ( hazard ratio 1.04 , 95 % confidence interval 0.73–1.48 , P = 0.839 ) . Conclusion : In hypertensive patients with ECG left ventricular hypertrophy with existing or new atrial fibrillation , digoxin use is not associated with a significantly increased risk of all-cause mortality after adjusting for other independent predictors of death and for the factors associated with the propensity to use digoxin in this population . These findings suggest that factors other than digoxin use may account for the increased mortality found with digoxin use in some studies . Clinical Trials Registration : http:// clinical BACKGROUND The Atrial Fibrillation Follow-up Investigation of Rhythm Management trial showed that digoxin was associated with increased mortality in patients with atrial fibrillation . OBJECTIVES To assess the association of digoxin with cardiovascular ( CV ) morbidity and mortality in patients with permanent atrial fibrillation enrolled in the Dutch Rate Control Efficacy in Permanent AF : A Comparison Between Lenient Versus Strict Rate Control II trial as well as to assess the role of digoxin to achieve heart rate targets . METHODS The primary outcome was a composite of CV morbidity and mortality . Secondary outcomes included CV hospitalization and all-cause mortality or heart failure ( HF ) hospitalization . Of the 614 patients , 608 ( 99 % ) completed the dose-adjustment phase . Outcome events were analyzed from the end of the dose-adjustment phase until the end of follow-up . The median follow-up period was 2.9 years ( interquartile range 2.7 - 3.0 years ) . RESULTS In total , 284 patients ( 46.7 % ) used digoxin after the dose-adjustment phase ( median dosage 0.250 mg ; interquartile range 0.0625 - 0.750 mg ) . These patients were more often women , previously admitted for HF , had an increased left ventricular end-systolic diameter , and more often r and omized to strict rate control . By using Cox proportional hazards regression analysis , the use of digoxin was not associated with an increased risk for the primary and secondary outcomes . For the primary outcome , the 3-year estimated cumulative incidence was 12.9 % vs 13.4 % in the digoxin group vs the no-digoxin group ( unadjusted hazard ratio [ HR ] 0.97 ; 95 % confidence interval [ CI ] 0.62 - 1.52 ) . Incidence was 19.4 % vs. 19.5 % for CV hospitalization ( unadjusted HR 1.00 ; 95 % CI 0.69 - 1.45 ) and 6.6 % vs. 9.9 % for all-cause mortality or HF hospitalization ( unadjusted HR 0.62 ; 95 % CI 0.34 - 1.13 ) in the digoxin group vs the no-digoxin group . CONCLUSION The use of digoxin was not associated with increased morbidity and mortality BACKGROUND Some evidence s suggest that the use of digoxin may be harmful inatrial fibrillation ( AF ) patients . The aim of the study was to investigate in a " real world " of AF patients receiving vitamin K antagonists ( VKAs )  , the relationship between digoxin use and mortality . METHODS Prospect i ve single-center observational study including 815 consecutive non-valvular AF patients treated with VKAs .  Total mortality was the primary outcome of the study . We also performed a sub- analysis considering only cardiovascular ( CV ) deaths . Time in therapeutic range ( TTR ) was used for anticoagulation quality . RESULTS Median follow-up was 33.2months ( 2460 person-years ) ; 171 ( 21.0 % ) patients were taking digoxin .  Compared to those without , patients on digoxin were older ( p=0.007 ) , with a clinical history of HF ( p<0.001 ) and at higher risk of thromboembolic events ( p<0.001 ) . No difference in TTR between the two groups was registered ( p=0.598 ) . During the follow-up , 85 deaths occurred : 47 CV and 38 non-CV deaths ; 35 deaths occurred in digoxin users ( 20.6 % ) . A significant increased rate of total mortality was observed in  digoxin-treated  patients ( p<0.001 ) . Multivariable analysis showed that digoxin was associated with total mortality ( hazard ratio [ HR ] : 2.224 , p<0.001 ) and CV death ( HR : 4.686 , p<0.001 ) . A propensity score-matched analysis confirmed that digoxin was associated with total mortality ( HR : 2.073 , p=0.0263 ) and CV death ( HR : 4.043 , p=0.004 ) . CONCLUSIONS In AF patients on good anticoagulation control with VKAs , digoxin use was associated with a higher rate of total and CV mortality OBJECTIVES This study examined the relative merits of digoxin , carvedilol , and their combination for the management of patients with atrial fibrillation ( AF ) and heart failure ( HF ) . BACKGROUND In patients with AF and HF , both digoxin and beta-blockers reduce the ventricular rate , and both may improve symptoms , but only beta-blockers have been shown to improve prognosis . If combined therapy is not superior to beta-blockers alone , treatment of patients with HF and AF could be simplified by stopping digoxin . METHODS We enrolled 47 patients ( 29 males ; mean age 68 years ) with persistent AF and HF ( mean left ventricular ejection fraction [ LVEF ] 24 % ) in a r and omized , double-blinded , placebo-controlled study . In the first phase of the study , digoxin was compared with the combination of digoxin and carvedilol ( four months ) . In the second phase , digoxin was withdrawn in a double-blinded manner in the carvedilol-treated arm , thus allowing a comparison between digoxin and carvedilol ( six months ) . Investigations were undertaken at baseline and at the end of each phase . RESULTS Compared with digoxin alone , combination therapy lowered the ventricular rate on 24-h ambulatory electrocardiographic monitoring ( p < 0.0001 ) and during submaximal exercise ( p < 0.05 ) , whereas LVEF ( p < 0.05 ) and symptom score ( p < 0.05 ) improved . In phase 2 , there was no significant difference between digoxin alone and carvedilol alone in any variable . The mean ventricular rate rose and LVEF fell when patients switched from combination therapy to carvedilol alone . Six-minute walk distance was not significantly influenced by any therapy . CONCLUSIONS The combination of carvedilol and digoxin appears generally superior to either carvedilol or digoxin alone in the management of AF in patients with HF Multiple trials have suggested the use of digoxin , digoxin and propranolol , or timolol to prevent atrial fibrillation after coronary artery bypass grafting . No trial has evaluated the efficacy of digoxin verus propranolol . Furthermore , the predictors of postoperative atrial fibrillation and the long-term consequence of atrial fibrillation that reverts to sinus rhythm have not been established . One hundred fifty patients were r and omized to receive no drug , propranolol ( 20 mg every 6 hours ) , or digoxin ( 0.5 mg followed by 0.25 mg daily ) . Twenty-seven patients were excluded from data analysis . In the remaining 123 patients , no preoperative parameter ( age , sex , diabetes , hypertension , smoking , electrocardiographic p wave morphology , or preoperative digoxin or propranolol therapy ) , intraoperative parameter ( bypass time , aortic cross-clamp time , or number of vessels bypassed ) , or postoperative parameter ( peak creatinine kinase , congestive heart failure , or pericarditis ) by univariate or multivariate analysis predicted patients at risk for atrial fibrillation . Sustained atrial fibrillation developed in 37.5 % of control and 32.6 % of digoxin-treated patients . Only 16.2 % of propranolol-treated patients had sustained atrial fibrillation ( p less than 0.03 ) . There were no in-hospital complications in those patients with atrial fibrillation . After 26 + /- 7 months follow-up , those patients with postoperative atrial fibrillation had no increased incidence of angina , cerebral vascular accident , myocardial infa rct ion , or sudden death . Therefore , in this select population , propranolol prophylaxis is effective but discretionary Objectives This study aims to assess whether digoxin has a different effect on mortality risk for women than it does for men in patients with heart failure ( HF ) . Design This study uses the UK-based The Health Information Network population data base in a cohort study of the impact of digoxin exposure on mortality for men and women who carry the diagnosis of HF .  Digoxin exposure was assessed based on prescribing data . Multivariable Cox proportional hazards models were used to assess whether there was an interaction between sex and digoxin affecting mortality hazard . Setting The setting was primary care outpatient practice s. Participants The study cohort consisted of 17 707 men and 19 227 women with the diagnosis of HF who contributed only time without digoxin exposure and 9487 men and 10 808 women with the diagnosis of HF who contributed time with digoxin exposure . Main outcome measures The main outcome measure was all-cause mortality . Results The primary outcome of this study was the absence of a large interaction between digoxin use and sex affecting mortality . For men , digoxin use was associated with a HR for mortality of 1.00 , while for women , the HR was also 1.00 ( p value for interaction 0.65 ) . The results of sensitivity analyses were consistent with those of the primary analysis . Conclusion Observational data do not support the concern that there is a substantial increased risk of mortality due to the use of digoxin in women . This finding is consistent with previous observational studies but discordant with results from a post hoc analysis of a r and omised controlled trial of digoxin versus placebo 1 . Rapid ventricular rate ( VR ) and rhythm irregularity during atrial fibrillation ( AF ) impair cardiac performance . Although digoxin has been widely used in patients with AF , its efficacy for the control of VR and rhythm irregularity is unsatisfactory . Whether low‐dose amiodarone is more effective remains unclear Aim : Recently , digoxin use has been found to associate with higher mortality . Yet , potential mechanisms by which digoxin use increases mortality remain unclear . Increased arrhythmogenicity from digoxin use is one possibility . Thus , we aim ed to evaluate the relation between digoxin and shock events in patients with implantable cardioverter defibrillators ( ICDs ) . Methods : We performed a retrospective chart review of all patients with ICDs and at least 1 device interrogation at our institution between January 1 , 2012 , and January 1 , 2015 . We aim ed to cover 1 year of interrogation period . Patients with heart failure , atrial fibrillation , or both were included in the analysis . Patients were divided into 2 groups based on digoxin use , defined as use of digoxin for any period of time during ICD interrogation period . Incidence of ICD shock events and electrical storms and hospitalizations were compared between the 2 groups . Results : The study included 202 patients . Of those , 55 patients were on digoxin and 147 were not on digoxin .  Patients on digoxin were more likely to receive ICD shocks ( odds ratio [ OR ] = 2.5 , 95 % confidence interval [ 95 % CI ] = 1.01 - 6.18 , P = .04 ) and have increased risk of electrical storms ( P = .02 ) . Moreover , total hospitalizations were higher in digoxin users ( P = .02 ) . Multivariate logistic regression analysis also showed that digoxin use was an independent predictor of shock events ( OR = 4.07 , 95 % CI = 1.43 - 11.58 , P = .009 ) . Conclusion : Digoxin is associated with increased shock events and electrical storms in patients with ICDs ; however , large r and omized controlled studies are needed to confirm our findings BACKGROUND The role of digoxin in the prognosis of patients with heart failure ( HF ) remains unclear . AIMS To evaluate the relationship of commencing treatment with digoxin ( CTDig ) with the mortality and the morbidity of patients with HF . METHODS Prospect i ve study over 8 years on 4467 patients with HF . Main outcomes were all-cause and cardiovascular mortality , hospitalisations and visits . We analyse the independent relationship of CTDig , with the mortality and the morbidity , stratifying patients for cardiovascular comorbidity , after propensity score-matching for potential confounders ( 1421 patients who CTDig vs. another 1421 patients non-exposed to digoxin )  . RESULTS During a median follow up of 46.1 months , 1872 patients ( 65.9 % ) died , and 2203 ( 77.5 % ) were hospitalised . CTDig was associated with a lower all-cause mortality ( HR = 0.90 [ 95 % CI , 0.84 - 0.97 ] ) , and cardiovascular mortality ( HR = 0.87 [ 0.81 - 0.96 ] ) , hospitalisation ( HR = 0.91 [ 0.86 - 0.97 ] ) , 30-day readmission for HF ( HR = 0.88 [ 0.79 - 0.95 ] ) , and visits ( HR = 0.94 [ 0.90 - 0.98 ] ) ( p < 0.001 in all cases ) , after adjustment for the propensity to take digoxin , other medications , and other potential confounders . These effects of digoxin were independent of gender , or type of HF ( systolic or non-systolic ) . CONCLUSION The data suggest that therapy with digoxin is associated with an improved mortality and morbidity of HF , including women and patients with non-systolic HF We retrospectively performed stepwise logistic regression analysis on 1,509 patients with chronic heart failure in 4 multicenter United States studies and 1 Australia-New Zeal and study to examine the effect of digoxin in patients r and omized to carvedilol  or  placebo . Patients receiving digoxin had more advanced heart failure , the incidence of hospitalization for any cause and the combination of all-cause death and all-cause hospitalization were the same in the digoxin versus no-digoxin groups Because of conflicting results from studies examining the usefulness of digoxin in congestive heart failure ( CHF ) patients in sinus rhythm , a cross-over trial was conducted in which 20 patients received 7 weeks of digoxin titrated to a level of 1.54 to 2.56 nmol/liter and 7 weeks of matched placebo .  The order of treatments was determined by r and om allocation and patients , clinicians and research staff were blind to allocation . In patients with deteriorating condition , the treatment period was terminated and outcome measures were obtained . If deterioration occurred during the first period , the patient was crossed over without the code being broken . Seven patients required premature termination of study periods because of increasing symptoms of CHF .  All 7 were taking placebo at the time ( p = 0.016 ) . Small differences in dyspnea ( p = 0.044 ) , walking test score ( p = 0.055 ) , clinical assessment of CHF ( p = 0.036 ) and ejection fraction ( p = 0.004 ) favored the digoxin treatment group . Patients with more severe CHF were more likely to benefit from digoxin administration . It was concluded that oral digoxin , in doses titrated to produce a serum level of 1.54 to 2.56 nmol/liter , improved quality of life and functional exercise capacity in some patients with CHF in sinus rhythm
The present systematic review and meta- analysis of all available data sources suggest that digoxin use is associated with an increased mortality risk , particularly among patients suffering from AF
There are conflicting data regarding the effect of digoxin use on mortality in patients with atrial fibrillation ( AF ) or with congestive heart failure ( CHF ) .
The aim of this meta- analysis was to provide detailed analysis of the currently available study reports .