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Digoxin and Mortality in Heart Failure - Atrial Fibrillation Patients
Results from CONAREC XVIII Registry

Ezequiel Zaidel, Gonzalo Perez, Lucas Corradi, Matias Galli, Rodolfo Leiva, Luciano Fallabrino CONAREC.



Digoxin is used since the 18th century, due to its physiopathologic benefits through lowering heart rate and inotropic properties. However, its effect on mortality is controversial, showing opposite results in different trials: In heart failure (HF) patients it increases ejection fraction and reduces hospitalization (PROVED, RADIANCE, DIG). European and American  registries and substudies of randomized clinical trials have shown an increase in CV events and mortality when Digoxin is used to lower heart rate in Atrial fibrillation (AF) patients (AFFIRM, TREAT-AF, ROCKET-AF).


To evaluate if digoxin is associated with in-hospital mortality in a contemporary cohort of decompensated heart failure patients with atrial fibrillation.


We used data from CONAREC 18th Registry, which is the largest and most recent multicentric heart failure registry in Latin America, developed by the Argentine Council of Cardiology Residents. It included acute decompensated heart failure patients (Pts) who were admitted to 64 cardiology residency hospitals during two consecutive months. For this study we excluded sinus rhythm Pts, and new onset AF patients, remaining 415 patients for the analysis. We evaluated baseline characteristics and predictors of in-hospital mortality.

Statistic analysis

Conventional descriptive statistic was developed. For comparisons we used  T test,  Chi2 or exact Fisher test as needed.  From univariate predictors of death we developed a multivariable model.  We used EpiInfo 7 and STATA statystic tools. A two-tailed P value of <.05 was considered signifficant.


AF HF Pts mean age was 78 years, 43% female. 83% had a personal history of hypertension and 23% renal failure. 119 patients (28,7%) were priorly treated with Digoxin. 53% had HF with preserved ejection fraction. Mean heart rate was 90. Ischemic etiology was the most frequent (25%). 177 Pts received Digoxin during  the first 24 hours.

The in hospital mortality was 10,4% in this group (43 Pts). Prior Digoxin use was associated with an increased risk of mortality in a univariate model. After adjustment to other variables (renal failure, shock, use of beta-blockers, diabetes), it remained as an independent predictor of death (OR 2,07 CI: 1,05-4,08, p=0.03).


Cross-sectional study (time on digoxin), no Digoxin serum levels, no data of dose of Digoxin used at admission.


In a contemporary cohort from Argentina of decompensated heart failure patients with history of atrial fibrillation, Digoxin use was associated to in-hospital mortality.