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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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Chronic digoxin utilization in patients with atrial fibrillation is associated with hospitalization for de novo acute heart failure
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Marco de Campos Beringuilho
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
Marco Beringuilho; j. Ferreira; i. Fialho; Daniel Candeias Faria; h. Ferreira; m. Passos; j. Lopes; d. Roque; c. Morais
Abstract
<p><strong>Background</strong>: The treatment of atrial fibrillation (AF) is complex. There are conflicting data regarding the effects of digoxin used for rate control in these patients.</p> <p><strong>Purpose</strong>: We aimed to evaluate the incidence of hospitalization for de novo acute heart failure (AHF) at 12-month follow-up in patients with atrial fibrillation who were under digoxin therapy.</p> <p><strong>Methods</strong>: We included retrospectively 2181 consecutive patients with AF who were evaluated in our Emergency Department (ED) in a 12 month period. Among them, 423 patients were admitted for in-hospital management. Patients who had previous known heart failure (n=101) were excluded. We determined the proportion of digoxin prescription at discharge. Primary outcome was the incidence of hospitalization for de novo AHF 12 months after discharge.</p> <p><strong>Results</strong>: We included 253 AF patients who were successfully discharged and followed for 12 months (mean age of 70.7 ± 12.6 years, 37.5% males). A total of 5.9% (n=15) had digoxin prescribed at discharge. Kaplan-Meier analysis (Figure) showed that patients with AF who were taking digoxin had a higher incidence of de novo AHF 12 months after discharge (28.6 vs. 10.1%; log-rank p=0.027). Multivariable Cox regression analysis controlled for age, gender, systemic hypertension, diabetes mellitus, pattern of AF (paroxysmal or non-paroxysmal), successful cardioversion at discharge, CHA2DS2VASc score, chronic kidney disease and glomerular filtration rate at discharge showed that digoxin therapy was an independent predictor of de novo AHF (HR 3.52; CI 95% 1.09 – 11.36; p=0.035). There was a trend towards a higher mortality rate 12 months after discharge in AF patients taking digoxin (26.7 vs. 10.5%; p=0.079).</p> <p><strong>Conclusions</strong>: Digoxin may be harmful in AF patients, as it is associated with hospitalization for de novo AHF, as well as a tendency towards higher mortality. This finding could have an impact on the management of patients with AF who are at risk of developing heart failure.</p>
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