Safety and efficacy of digoxin: systematic review and meta-analysis of observational and controlled trial data

@article{Ziff2015SafetyAE,
  title={Safety and efficacy of digoxin: systematic review and meta-analysis of observational and controlled trial data},
  author={Oliver Jonathan Ziff and Deirdre A. Lane and Monica Samra and Michael Griffith and Paulus Kirchhof and Gregory Y. H. Lip and Richard Paul Steeds and Jonathan N Townend and Dipak Kotecha},
  journal={The BMJ},
  year={2015},
  volume={351}
}
Objective To clarify the impact of digoxin on death and clinical outcomes across all observational and randomised controlled trials, accounting for study designs and methods. Data sources and study selection Comprehensive literature search of Medline, Embase, the Cochrane Library, reference lists, and ongoing studies according to a prospectively registered design (PROSPERO: CRD42014010783), including all studies published from 1960 to July 2014 that examined treatment with digoxin compared with… Expand
Digoxin–mortality: randomized vs. observational comparison in the DIG trial
TLDR
Prescription of digoxin is an indicator of disease severity and worse prognosis, which cannot be fully accounted for by covariate adjustments in the DIG trial where patients were well-characterized, and is unlikely that weaker research approaches can provide more reliable estimates of the effects of cardiac glycosides. Expand
Effect of Digoxin Therapy on Mortality in Patients With Atrial Fibrillation: An Updated Meta-Analysis
  • Xiaoxu Wang, Yi Luo, Dan Xu, Kun Zhao
  • Medicine
  • Frontiers in Cardiovascular Medicine
  • 2021
Background: Whether digoxin is associated with increased mortality in atrial fibrillation (AF) remains controversial. We aimed to assess the risk of mortality and clinical effects of digoxin use inExpand
Influence of digoxin on mortality in patients with atrial fibrillation: Overview of systematic reviews
TLDR
An overview of systematic reviews found general consistency regarding the association between digoxin use and higher all‐cause mortality in AF populations and an unmet need exists for additional study in a RCT setting with close monitoring and reporting of SDC to better inform clinical practice. Expand
Meta-Analysis of Effects of Digoxin on Survival in Patients with Atrial Fibrillation or Heart Failure: An Update.
TLDR
It is confirmed that digoxin use is associated with increased mortality in patients with atrial fibrillation and with heart failure. Expand
Digoxin Toxicity and Use of Digoxin Immune Fab: Insights From a National Hospital Database.
TLDR
There was no difference for in-hospital mortality or length of stay compared with patients not receiving DIF, and opportunities exist for improved diagnosis and post-DIF management. Expand
Comparison of clinical profiles between takotsubo syndrome and acute coronary syndrome: a systematic review and meta-analysis
TLDR
TTS has significantly different clinical characteristics than ACS, however, the in-hospital and long-term overall mortality rates are not trivial for TTS patients, and some presenting features were significantly associated with all-cause mortality. Expand
Mortality among patients due to adverse drug reactions that lead to hospitalization: a meta-analysis
TLDR
Subgroup analysis showed a higher prevalence of fatal ADRAd in intensive care units, emergency departments, multispecialty wards and whole hospitals, and computer-based monitoring systems in combination with other methods detected higher mortality. Expand
Meta-analyses frequently pooled different study types together: a meta-epidemiological study.
TLDR
Although treatment effects did not differ between them on average, many meta-analyses including both observational studies and RCTs pool results from both study types, and it is identified situations for which estimates differed. Expand
Digoxin Benefit Varies by Risk of Heart Failure Hospitalization: Applying the Tufts MC HF Risk Model.
TLDR
Participants in the DIG study at higher risk of hospitalization as identified by a multistate model were considerably more likely to benefit from digoxin therapy to reduce heart failure hospitalization. Expand
Association Between Digoxin Use and Adverse Outcomes Among Patients in the Chinese Atrial Fibrillation Registry
TLDR
Although residual confounders may exist, and serum concentrations of digoxin were unavailable, digoxin should be used with caution in clinical practice, and its effects need to be critically evaluated in randomized trials. Expand
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 134 REFERENCES
Digoxin-associated mortality: a systematic review and meta-analysis of the literature.
TLDR
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. Expand
Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: a retrospective analysis.
TLDR
Retrospective analysis of data from the DIG trial indicates a beneficial effect of digoxin on morbidity and no excess mortality in women at serum concentrations from 0.5 to 0.9 ng/ml, whereas serum concentrations > or =1.2 ng/ ml seem harmful. Expand
Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study.
TLDR
Digoxin was not associated with increased all-cause mortality, survival free of admission due to any cause, or admission to cardiovascular causes, regardless of underlying heart failure. Expand
Economic outcomes of withdrawal of digoxin therapy in adult patients with stable congestive heart failure.
TLDR
The continuation of digoxin therapy in patients with stable congestive heart failure should be strongly considered, because this strategy is likely to lead to both lower costs and greater health benefits on the basis of available information. Expand
Observational cohort study of the safety of digoxin use in women with heart failure
TLDR
Observational data do not support the concern that there is a substantial increased risk of mortality due to the use of digoxin in women, and this finding is consistent with previous observational studies but discordant with results from a post hoc analysis of a randomised controlled trial ofDigoxin versus placebo. Expand
Association of serum digoxin concentration and outcomes in patients with heart failure.
TLDR
It is demonstrated that higher SDCs were associated with increased mortality and suggested that the effectiveness of digoxin therapy in men with heart failure and a left ventricular ejection fraction of 45% or less may be optimized in the SDC range of 0.5 to 0.8 ng/mL. Expand
Increased mortality associated with digoxin in contemporary patients with atrial fibrillation: findings from the TREAT-AF study.
TLDR
Digoxin was associated with increased risk of death in patients with newly diagnosed AF, independent of drug adherence, kidney function, cardiovascular comorbidities, and concomitant therapies, and these findings challenge current cardiovascular society recommendations on use of digoxin in AF. Expand
Increased mortality among patients taking digoxin--analysis from the AFFIRM study.
TLDR
Findings call into question the widespread use of digoxin in patients with AF after correcting for clinical characteristics and comorbidities, regardless of gender or of the presence or absence of HF. Expand
Are coronary patients at higher risk with digoxin therapy? An ongoing controversy.
TLDR
The administration of digoxin to survivors of an acute myocardial infarction in the chronic phase of their disease, is statistically associated with a 30-50% increase in the risk of overall and cardiac mortality during long-term follow-up. Expand
The effect of digoxin on mortality and morbidity in patients with heart failure.
TLDR
Digoxin did not reduce overall mortality, but it reduced the rate of hospitalization both overall and for worsening heart failure, which defines more precisely the role of digoxin in the management of chronic heart failure. Expand
...
1
2
3
4
5
...