Digoxin Use in A-Fib: A Last Resort

Debate continues about the effectiveness and safety of digoxin. Many recent studies have raised concerns about its use in atrial fibrillation. Investigators have now assessed the use of digoxin and outcomes associated with its use among patients in the manufacturer-funded ROCKET AF trial who had atrial fibrillation and risk factors for stroke.

Of the 14,171 patients in ROCKET AF, 37% were treated with digoxin; these patients were more likely to have heart failure, diabetes, and persistent atrial fibrillation. The use of digoxin was not associated with the risk for stroke or systemic embolism — or bleeding. However, digoxin was associated with significantly higher mortality (adjusted hazard ratio, 1.17). Vascular death and sudden death were a…