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Effect of digoxin on all-cause and cardiovascular mortality in patients with atrial fibrillation with and without heart failure: an umbrella review of systematic reviews and 12 meta-analyses.
Gazzaniga, Gianluca; Menichelli, Danilo; Scaglione, Francesco; Farcomeni, Alessio; Pani, Arianna; Pastori, Daniele.
Afiliación
  • Gazzaniga G; Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, 20122, Milan, Italy.
  • Menichelli D; Department of General and Specialized Surgery "Paride Stefanini", Sapienza University of Rome, 00185, Rome, Italy.
  • Scaglione F; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.
  • Farcomeni A; Department of Chemical-Clinical and Microbiological Analyses, Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy.
  • Pani A; Department of Economics and Finance, University of Rome ":Tor Vergata", 00133, Rome, Italy.
  • Pastori D; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.
Eur J Clin Pharmacol ; 79(4): 473-483, 2023 Apr.
Article en En | MEDLINE | ID: mdl-36872367
PURPOSE: To perform a systematic umbrella review with meta-analysis to evaluate the certainty of evidence on mortality risk associated with digoxin use in patients with atrial fibrillation (AF) with or without heart failure (HF). METHODS: We systematically searched MEDLINE, Embase, and Web of Science databases from inception to 19 October 2021. We included systematic reviews and meta-analyses of observational studies investigating digoxin effects on mortality of adult patients with AF and/or HF. The primary outcome was all-cause mortality; secondary outcome was cardiovascular mortality. Certainty of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool and the quality of systematic reviews/meta-analyses by the A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR2) tool. RESULTS: Eleven studies accounting for 12 meta-analyses were included with a total of 4,586,515 patients. AMSTAR2 analysis showed a high quality in 1, moderate in 5, low in 2, and critically low in 3 studies. Digoxin was associated with an increased all-cause mortality (hazard ratio [HR] 1.19, 95% confidence interval [95%CI] 1.14-1.25) with moderate certainty of evidence and with an increased cardiovascular mortality (HR 1.19, 95%CI 1.06-1.33) with moderate certainty of evidence. Subgroup analysis showed that digoxin was associated with all-cause mortality both in patients with AF alone (HR 1.23, 95%CI 1.19-1.28) and in those with AF and HF (HR 1.14, 95%CI 1.12-1.16). CONCLUSION: Data from this umbrella review suggests that digoxin use is associated with a moderate increased risk of all-cause and cardiovascular mortality in AF patients regardless of the presence of HF. TRIAL REGISTRATION: This review was registered in PROSPERO (CRD42022325321).
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Fibrilación Atrial / Insuficiencia Cardíaca Tipo de estudio: Observational_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Eur J Clin Pharmacol Año: 2023 Tipo del documento: Article País de afiliación: Italia

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Fibrilación Atrial / Insuficiencia Cardíaca Tipo de estudio: Observational_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Eur J Clin Pharmacol Año: 2023 Tipo del documento: Article País de afiliación: Italia