Evidence map›Paper›PMID 23592708›Full record

Trial reportEuropean heart journal2013

Lack of evidence of increased mortality among patients with atrial fibrillation taking digoxin: findings from post hoc propensity-matched analysis of the AFFIRM trial.

Mihai Gheorghiade, Gregg C Fonarow, Dirk J van Veldhuisen, John G F Cleland, Javed Butler, Andrew E Epstein, Kanan Patel, Inmaculada B Aban, Wilbert S Aronow, Stefan D Anker and 1 more

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European heart journal, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 64 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
64citing papers in PubMed, 8 pooled it
19.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

64 citing papers in PubMed, 8 syntheses or guidelines pooled it, 191 citations in OpenAlex.

  1. Pooled it
  2. Population Pharmacokinetic Studies of Digoxin in Adult Patients: A Systematic Review.European journal of drug metabolism and pharmacokinetics · 2021
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Guideline
  8. Guideline
  9. Modelling anticoagulation and health-related quality of life in those with atrial fibrillation: a secondary analysis of AFFIRM.Clinical research in cardiology : official journal of the German Cardiac Society · 2024
    Trial
  10. Trial
  11. Trial
  12. Trial
  13. Review
  14. Article
  15. Digitalis Therapy Is Associated With an Increased Risk of ICD Shock Delivery and Device Revision.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2025
    Article
  16. Review
  17. Article
  18. Review
  19. Article
  20. Article

4 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 9 institutions in 4 countries.

Mihai GheorghiadeNorthwestern University, Chicago, IL, USA.
Gregg C Fonarow
Dirk J van Veldhuisen
John G F Cleland
Javed Butler
Andrew E Epstein
Kanan Patel
Inmaculada B Aban
Wilbert S Aronow
Stefan D Anker
Ali Ahmed
University of Alabama at Birmingham · USEmory University · USHull York Medical School · GBNew York Medical College · USNorthwestern University · USUniversity Medical Center Groningen · NLUniversity of California, Los Angeles · USUniversity of Pennsylvania · USVita-Salute San Raffaele University · IT

Funding

Heart failure, chronic kidney disease, and renin-angiotensin system inhibitionR01HL085561 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2006 to 2009
$1.5M
Neurohormonal Blockade and Outcomes in Diastolic Heart FailureR01HL097047 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2009 to 2010
$915k
NHLBI NIH HHS R01 HL085561NHLBI NIH HHS R01-HL085561-SNHLBI NIH HHS R01 HL097047NHLBI NIH HHS R01-HL097047
6 · The paper itself

Abstract

aimsDigoxin is recommended for long-term rate control in paroxysmal, persistent, and permanent atrial fibrillation (AF). While some analyses suggest an association of digoxin with a higher mortality in AF, the intrinsic nature of this association has not been examined in propensity-matched cohorts, which is the objective of the current study. METHODS AND

resultsIn Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM), 4060 patients with paroxysmal and persistent AF were randomized to rate (n = 2027) vs. rhythm (n = 2033) control strategies. Of these, 1377 received digoxin as initial therapy and 1329 received no digoxin at baseline. Propensity scores for digoxin use were estimated for each of these 2706 patients and used to assemble a cohort of 878 pairs of patients receiving and not receiving digoxin, who were balanced on 59 baseline characteristics. Matched patients had a mean age of 70 years, 40% were women, and 11% non-white. During the 3.4 years of the mean follow-up, all-cause mortality occurred in 14 and 13% of matched patients receiving and not receiving digoxin, respectively [hazard ratio (HR) associated with digoxin use: 1.06; 95% confidence interval (CI): 0.83-1.37; P = 0.640]. Among matched patients, digoxin had no association with all-cause hospitalization (HR: 0.96; 95% CI: 0.85-1.09; P = 0.510) or incident non-fatal cardiac arrhythmias (HR: 0.90; 95% CI: 0.37-2.23; P = 0.827). Digoxin had no multivariable-adjusted or propensity score-adjusted associations with these outcomes in the pre-match cohort.

conclusionsIn patients with paroxysmal and persistent AF, we found no evidence of increased mortality or hospitalization in those taking digoxin as baseline initial therapy.

Indexed as

AgedAnti-Arrhythmia AgentsAtrial FibrillationCause of DeathDigoxinFemaleHeart FailureHospitalizationHumansKaplan-Meier EstimateMalePropensity ScoreTreatment OutcomeAnti-Arrhythmia AgentsDigoxinAtrial fibrillationDigoxinHospitalizationMortalityPropensity score

Identifiers

PMID23592708
PMCPMC3659306
OpenAlexW2128605957

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.