Safety of Digoxin in Nonagenarian Patients with Atrial Fibrillation. Lessons from a Spanish multicenter registry

• Published in: European heart journal Vol. 42; no. Supplement_1
• Main Authors: Dominguez Erquicia, P, Raposeiras Roubin, S, Abu-Asi, E, Cespon Fernandez, M, Alonso Rodriguez, D, Camacho Freire, S J, Curbelos Fernandez, N, Lopez Masjuan Rios, A, Melendo Viu, M, Iniguez Romo, A
• Format: Journal Article
• Language: English
• Published: 12.10.2021
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehab724.2927

Abstract Background The association between digoxin and mortality is an unclear issue. In older patients with atrial fibrillation (AF), where the use of digoxin is frequent, the evidence of its safety is very scarce. Aim Our aim is to assess the safety of digoxin in nonagenarian patients with AF in terms of mortality. Methods We evaluated data from 795 patients ≥90 years old of a multicenter Spanish retrospective registry of nonagenarian patients with non-valvular AF and rate control. We analyzed the relationship between digoxin and mortality with a Cox proportional-hazards model and Kaplan-Meier survival curves. Results The follow-up was 27.7±18.3 months. Mean age was 92.5±3.8 years (inter quartilile range 90.0–112.7), and 71% of patients were female. Digoxin was not associated with increased risk of mortality (aHR 1.16; 95% CI: 0.96–1.41, P=0.128) in the total sample. However, we found a significant increase in mortality in the group with estimated glomerular filtration rate (eGFR) <30 ml /min/1.73 m2 (aHR 2.01; 95% CI: 1.13–3.57, P=0.018), but not in the other subgroups of eGFR (30–59/≥60 ml/min/1.73 m2). When exploring the risk of mortality according to gender, the male subgroup was associated with an increase in mortality (aHR 1.48; 95% CI: 1.02–2.14, P=0.041). This was not observed in female subgroup (aHR 1.03; 95% CI: 0.81–1.29, P=0.829). Based on the presence or absence of a history of heart failure (HF), we did not find significant differences in the association between digoxin and all-cause mortality (aHR 1.20; 95% CI: 0.87–1.65, P=0.268 vs aHR 1.15; 95% CI: 0.90–1.47, P=0.273, respectively). Conclusions In our large registry of nonagenarian patients with AF, we did not find an association between digoxin and mortality in the total sample. However, in the subgroup analyses, we found an increase in mortality with the use of digoxin in men and in patients with an eGFR<30ml /min/1.73 m2. Funding Acknowledgement Type of funding sources: None. Kaplan-Meier estimates survival functionMortality by subgroups