Letter to the Editor
Digoxin: Time to Reconsider Its Role in Atrial Fibrillation?
AbstractTo the Editor:
Digoxin is one of the oldest drugs available and has been used extensively in heart failure and the control of ventricular rate for atrial fibrillation (AF). The recently published propensity-adjusted analysis of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial demonstrated that digoxin is associated with a 41% increase in mortality (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.19–1.67; P < 0.001), cardiovascular mortality (HR 1.35, 95% CI 1.06–1.71; P = 0.016), and arrhythmic mortality (HR 1.61, 95% CI 1.12–2.30; P = 0.009)1 when prescribed for AF after controlling for other comorbidites (including with and without heart failure).1 Are these results relevant to clinical practice? There are a few potential explanations for these results.
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