Digoxin therapy and survival in heart failure in sinus rhythm

The effect of digoxin therapy on the survival of heart failure patients in sinus rhythm was assessed using a retrospective case control study. Patients with an acute exacerbation of chronic heart failure secondary to ischaemic heart disease were selected. All were in sinus rhythm and all were treated with digoxin. Case-matched controls were identified for all digoxin-treated patients. Long-term survival was ascertained for all 18 digoxin-treated patients and 18 controls who formed the study population. The relative risk of death was 6.4 for digoxin-treated patients (95% confidence interval 0–36) during the period of hospitalization. The increased risk of death among digoxin-treated patients persisted up to 1 year following discharge from hospital. The results raise further concern regarding the safety of digoxin therapy in managing heart failure exacerbations, when the patients are in sinus rhythm.