Abstract<br />Background:Digoxin is recommended for long-term rate control in paroxysmal, persistent, and permanent atrial fibrillation (AF). While some analyses suggest an association of digoxin with a higher mortality in AF, the intrinsic nature of this association has not been examined in propensity-matched cohorts, which is the objective of the current study<br />Objectives:The goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with AF and if the association was modified by heart failure and/or serum digoxin concentration.<br />Methods:The association between digoxin use and mortality was assessed in 17,897 patients by using a propensity score–adjusted analysis and in new digoxin users during the trial versus propensity score–matched control participants. The authors investigated the independent association between serum digoxin concentration and mortality after multivariable adjustment.<br />RESULTS: A total of 29 studies with a total of 621,478 patients were included. Digoxin use was associated with an increased risk of all-cause mortality in all patients with atrial fibrillation (HR 1.17, 95% CI 1.13-1.22, p<0.001), especially in patients without heart failure (HR 1.28, 95% CI 1.11-1.47 , P<0.001). There was no significant association between digoxin and mortality in patients with atrial fibrillation and heart failure (HR 1.06, 95% CI 0.99-1.14, p=0.110). Digoxin use was associated with sudden cardiac death (SCD) (HR 1.40, 95% CI 1.23-1.60, P<0.001) and cardiovascular (CV) mortality in all patients with atrial fibrillation, with or without heart failure Associated with increased risk (HR 1.27, 95% CI 1.08-1.50, P<0.001) and digoxin use was not significantly associated with all-cause hospitalization(HR1.13, 95% CI 0, 92-1.39, P=0.230) . Conclusions: We concluded that digoxin use was associated with an increased risk of all-cause mortality, cardiovascular mortality, and SCD, and did not reduce readmission rates for atrial fibrillation, with or without heart failure. Digoxin may have a neutral effect on all-cause mortality in patients with atrial fibrillation and heart failure.<br /><br />By: Dr. Murtada Mohammed Hameed