Previous research has yielded conflicting evidence on the use of digoxin in patient with atrial fibrillation (AF) or congestive heart failure (CHF), but the largest systematic review and meta-analysis suggests that there is an increased risk of all-cause mortality with digoxin use in these patients.

In the study published in the European Heart Journal, data from 19 relevant studies on 235,047 AF patients and 91,379 CHF patients from 1993–2004 were analyzed on the effects of digoxin on all-cause mortality. Digoxin use increased the relative risk of all-cause mortality by 21% in AF and CHF patients; digoxin was linked to a 29% greater mortality risk among AF patients and 14% in CHF patients compared to controls not receiving glycosides.

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Because there has been only one prospective randomized controlled trial of digoxin in CHF patients and none in AF patients, the study authors urge that trials be conducted to examine the use of digoxin for both conditions and compare safety and efficacy against a placebo or other treatment. The narrow therapeutic index of digoxin and its potential interactions with other drugs like dronedarone are of particular concern to researchers.

Digoxin is indicated for the treatment of mild-to-moderate heart failure (with a diuretic and an ACE inhibitor when possible) and control of ventricular response rate in chronic AF in patients >2 years of age.

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