A popular drug used to treat heart disease may increase the risk of death in patients with heart problems, a new large-scale research has claimed.
There is conflicting evidence about whether digoxin, a drug that has been used worldwide for centuries to treat heart disease, might contribute to an increase in deaths in patients with atrial fibrillation (AF) or congestive heart failure (CHF).
Now, the largest review of all the evidence to date shows that it is associated with an increased risk of death in these patients, particularly in those being treated for AF.
Researchers from the JW Goethe University in Frankfurt, Germany, conducted a systematic review and meta-analysis of all studies published in peer-reviewed journals between 1993-2014 that looked at the effects of digoxin on death from any cause in AF and CHF patients.
They identified 19 relevant studies that included a total of 326,426 patients (235,047 AF and 91,379 CHF patients).
They found that among patients who were treated with digoxin, there was an overall 21 per cent increased risk of death from any cause compared to patients who were not receiving this treatment.
When they looked at the group of AF patients and the group of CHF patients separately, digoxin was associated with a 29 per cent and 14 per cent increased risk of death from any cause respectively, when compared to patients not receiving the drug.
Digoxin is extracted from the foxglove plant (digitalis) and it helps the heart beat more strongly and with a more regular rhythm.
It is commonly used in patients with atrial fibrillation (an irregular heartbeat) and also in patients with heart failure (congestive heart failure is when the heart’s function as a pump is impaired).
However, it can be difficult to use successfully as there is a narrow dose range at which it is effective and beyond which it can be dangerous.
Regular blood tests are required to test the levels of digoxin in the blood and high levels have been correlated with an increased death rate in patients.
Currently, its use is recommended in guidelines from the US and from the European Society of Cardiology for patients with heart failure and problems with control of the heart’s rhythm.
Researchers call for randomised controlled trials of digoxin, saying “until such proper randomised controlled trials are being completed, digoxin should be used with great caution (including monitoring plasma levels), particularly when administered for rate control in AF.”
“Our analysis, together with evidence from other studies, all point in the same direction: there is harm associated with the use of digoxin,” Stefan Hohnloser, Professor of Cardiology at the university, who led the study, said.
The study was published in the European Heart Journal.