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    How Dangerous is Digoxin in AF?

    The relationship between digoxin and atrial fibrillation (AF) is complicated. It is widely prescribed in this population, mainly for rate control, yet there are no randomized controlled trial s(RCT) to support this use. Observational studies show conflicting results about the adverse effects of digoxin in AF. In patients with AF and comorbid heart failure (HF) digoxin may be used to treat both. Guidelines on AF from the ACC/AHA/Heart Rhythm Society and the ESC recommend digoxin for rate control, but with caveats.1,2

    A primary unanswered question is whether poor clinical outcomes seen with digoxin are cause and effect or may be the result of confounding, and particularly by the presence of HF.

    Here we summarize a recent post-hoc analysis, published in the Journal of the American Heart Association, of the multinational RCT of edoxaban and warfarin   that used The current study used a large contemporary cohort of patients with AF and with and without HF to analyze the association between digoxin and fatal and nonfatal events. 

    Click here for the first slide

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