A1 Refereed original research article in a scientific journal
Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation
Authors: Kytö Ville, Saraste Antti, Rautava Päivi, Tornio Aleksi
Publisher: WILEY
Publication year: 2022
Journal: Basic and Clinical Pharmacology and Toxicology
Journal name in source: BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY
Journal acronym: BASIC CLIN PHARMACOL
Volume: 130
Issue: 6
First page : 655
Last page: 665
Number of pages: 11
ISSN: 1742-7835
DOI: https://doi.org/10.1111/bcpt.13733
Web address : https://doi.org/10.1111/bcpt.13733
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/175200673
Digoxin is used for rate control in atrial fibrillation (AF), but evidence for its efficacy and safety after myocardial infarction (MI) is scarce and mixed. We studied post-MI digoxin use effects on AF patient outcomes in a nationwide registry follow-up study in Finland. Digoxin was used by 18.6% of AF patients after MI, with a decreasing usage trend during 2004-2014. Baseline differences in digoxin users (n = 881) and controls (n = 3898) were balanced with inverse probability of treatment weight adjustment. The median follow-up was 7.4 years. Patients using digoxin after MI had a higher cumulative all-cause mortality (77.4% vs. 72.3%; hazard ratio [HR]: 1.19; confidence interval [CI]: 1.07-1.32; p = 0.001) during a 10-year follow-up. Mortality differences were detected in a subgroup analysis of patients without baseline heart failure (HF) (HR: 1.23; p = 0.019) but not in patients with baseline HF (HR: 1.05; p = 0.413). Cumulative incidences of HF hospitalizations, stroke and new MI were similar between digoxin group and controls. In conclusion, digoxin use after MI is associated with increased mortality but not with HF hospitalizations, new MI or stroke in AF patients. Increased mortality was detected in patients without baseline HF. Results suggest caution with digoxin after MI in AF patients, especially in the absence of HF.
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