By Barnaby Nicolas, MSIS
In our monthly “Article Spotlight” series, we’re showcasing achievements of Mount Sinai faculty and researchers using Altmetrics. This month, we’re looking at an article co-written by Dr. Jonathan Halperin, MD, Professor, Medicine, Cardiology at Icahn School of Medicine at Mount Sinai. The article examines the use of digoxin to treat atrial fibrillation.
Citation: Washam JB, Stevens SR, Lokhnygina Y, Halperin JL, Breithardt G, Singer DE, et al. Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). The Lancet.385(9985):2363-70.
Article Summary: This study examines the use and outcomes of digoxin in patients. Digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF. This association was independent of other measured prognostic factors, and although residual confounding could account for these results, these data show the possibility of digoxin having these effects. The researchers find that a randomised trial of digoxin in treatment of AF patients with and without heart failure is needed.
BACKGROUND: Atrial fi brillation (AF) is the most common arrhythmia encountered in clinical practice, estimated to currently affect more than 30 million people worldwide. It is associated with increased risk of stroke, heart failure, cognitive impairment, and death, and complicates management of other disorders. Digoxin is a widely used drug for ventricular rate control in patients with atrial fi brillation (AF), despite a scarcity of randomised trial data. The researchers studied the use and outcomes of digoxin in patients in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism
Trial in Atrial Fibrillation (ROCKET AF). For this retrospective analysis, the authors included and classifi ed patients from ROCKET AF on the basis of digoxin use at baseline and during the study. Patients in ROCKET AF were recruited from 45 countries and had AF and risk factors putting them at moderate-to-high risk of stroke, with or without heart failure. The researchers used Cox proportional hazards regression models adjusted for baseline characteristics and drugs to investigate the association of digoxin with all-cause mortality, vascular death, and sudden death. ROCKET AF was registered with ClinicalTrials.gov, number NCT00403767. In 14,171 randomly assigned patients, digoxin was used at baseline in 5239 (37%). Patients given digoxin were more likely to be female (42% vs 38%) and have a history of heart failure (73% vs 56%), diabetes (43% vs 38%), and persistent AF (88% vs 77%; p<0·0001 for each comparison). After adjustment, digoxin was associated with increased all-cause mortality, vascular death, and sudden death.