Digoxin confers a 71% higher risk of death and a 63% higher risk of hospitalization in patients with atrial fibrillation but no heart failure, noted a team of researchers in Circulation: Arrhythmia and Electrophysiology.

“Our findings suggest that the use of digoxin should be re-evaluated for the treatment of atrial fibrillation in contemporary clinical practice,” explained study coauthor Anthony Steimle, MD, of Kaiser Permanente (KP), in a press release from the health organization. “Given the other options available for heart-rate control, digoxin should be used with caution in the management of atrial fibrillation, especially in the absence of symptomatic systolic heart failure.”

As noted in the KP statement, digoxin is recommended in practice guidelines on atrial fibrillation for resting heart-rate control in sedentary individuals.

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The study group consisted of 15,000 adults in KP’s Northern and Southern California facilities who had received a recent diagnosis of atrial fibrillation but had no history of heart failure or digoxin use. Among the cohort, 4,858 (17.8%) began using digoxin.

A total of 1,140 deaths occurred, with the mortality rate significantly higher among digoxin users than nonusers (8.3 vs. 4.9 per 100 person-years). Within the 8,456 hospitalizations for any cause, the rate of hospitalization was higher for patients who took digoxin than for those who did not (60.1 vs. 37.2 per 100 person-years).