The aim of the study was to determine the influence of the previous use of digoxin on the hospital mortality and complications of patients admitted because of acute coronary syndrome (ACS). We analyzed the data of patients included in the ARIAM-Andalucia Registry, which involves 49 hospitals in Andalucia, Spain, from 2007 to 2012. Patients on digoxin treatment prior to their admission because of ACS constituted the digoxin group (DG), and were compared with the group of patients not on digoxin. Logistic regression and propensity score matching were used to analyze the differences. We included 20,331 patients, of whom 244 (1.2 %) were on digoxin. DG patients were older (73.1 vs 63.7 years old), more often women, and had more diabetes, hypertension, previous myocardial infarction, heart failure, stroke, atrial fibrillation, peripheral vascular disease, obstructive pulmonary disease or kidney disease. On univariate analysis, DG patients had significantly higher hospital mortality (13.5 vs 5.3 % P < 0.001), and more cardiogenic shock, but less ventricular fibrillation, and no differences in atrioventricular block, stroke or reinfarction. After the multivariate analysis, DG had no significant influence on hospital prognosis [odds ratio (OR) 1.21, 95 % confidence interval 0.79–1.86]. The analysis of a propensity-matched cohort of 464 patients (232 DG and 232 NoDG) did not find differences in hospital mortality (13.4 vs 13.4 %) nor other complications. In our cohort of ACS patients, the previous treatment with digoxin was not associated with an increase in dysrhythmic complications nor was an independent predictor of mortality during hospitalization.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Acute coronary syndrome
Patients on digoxin treatment previously to their admission
Patients not on digoxin treatment previously to their admission
Acute coronary syndrome without ST elevation
Acute coronary syndrome with ST elevation
Doherty JE (1973) Digitalis glycosides. Pharmacokinetics and their clinical implications. Ann Intern Med 79:229–238
Hauptman PJ, Kelly RA (1999) Digitalis. Circulation 99:1265–1270
Butler VP Jr (1970) Digoxin: immunologic approaches to measurement and reversal of toxicity. N Engl J Med 283:1150–1156
Garcia-Rubira JC, Suarez A, Ibañez B (2012) Ventricular fibrillation after correct pacing in digoxin intoxication. J Emerg Med 42:e93–e94
Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Katz SD, Klapholz M, Moser DK, Rogers JG, Starling RC, Stevenson WG, Tang WH, Teerlink JR, Walsh MN (2010) HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail 16:e1–e194
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A; ESC Committee for Practice Guidelines (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847
Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429
Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van’t Hof A, Widimsky P, Zahger D (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33:2569–2619
Whitbeck MG, Charnigo RJ, Khairy P, Ziada K, Bailey AL, Zegarra MM, Shah J, Morales G, Macaulay T, Sorrell VL, Campbell CL, Gurley J, Anaya P, Nasr H, Bai R, Di Biase L, Booth DC, Jondeau G, Natale A, Roy D, Smyth S, Moliterno DJ, Elayi CS (2013) Increased mortality among patients taking digoxin—analysis from the AFFIRM study. Eur Heart J 34:1481–1488
Consejeria de Salud de la Junta de Andalucia (2009). Orden de 3 de Septiembre de 2009 por la que se crea el fichero con datos de caracter personal denominado Registro de Cardiopatías ARIAM. Boletín Oficial de la Junta de Andalucía 192:59–60. http://juntadeandalucia.es/boja/2009/192/38
Saturno PJ, Felices F, Segura J, Vera A, Rodriguez JJ (2000) Reducing time delay in the thrombolysis of myocardial infarction: an internal quality improvement project. ARIAM Project Group. Analisis del Retraso en Infarto Agudo de Miocardio. Am J Med Qual 15:85–93
Ruiz-Bailén M, Aguayo de Hoyos E, Serrano-Córcoles MC, Diáz-Castellanos MA, Ramos-Cuadra JA, Reina-Toral A (2001) Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation. Intensive Care Med 27:1050–1057
Ruiz-Bailén M, Aguayo de Hoyos E, Ramos-Cuadra JA, Díaz-Castellanos MA, Issa-Khozouz Z, Reina-Toral A, López-Martínez A, Calatrava-López J, Laynez-Bretones F, Castillo-Parra JC, De La Torre-Prados MV, ARIAM Group (2002) Influence of age on clinical course, management and mortality of acute myocardial infarction in the Spanish population. Int J Cardiol 85:285–296
Rubin DB (1997) Estimating causal effects from large data sets using propensity scores. Ann Intern Med 127:757–763
D’Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17:2265–2281
Gheorghiade M, Fonarow GC, van Veldhuisen DJ, Cleland JG, Butler J, Epstein AE, Patel K, Aban IB, Aronow WS, Anker SD, Ahmed A (2013) Lack of evidence of increased mortality among patients with atrial fibrillation taking digoxin: findings from post hoc propensity-matched analysis of the AFFIRM trial. Eur Heart J 34:1489–1497
Jaeschke R, Oxman AD, Guyatt GH (1990) To what extent do congestive heart failure patients in sinus rhythm benefit from digoxin therapy? A systematic overview and meta-analysis. Am J Med 88:279–286
Køber L, Torp-Pedersen C, Gadsbøll N, Hildebrandt P, Høilund-Carlsen PF (1994) Is digoxin an independent risk factor for long-term mortality after acute myocardial infarction? Eur Heart J 15:382–388
Packer M, Gheorghiade M, Young JB, Costantini PJ, Adams KF, Cody RJ, Smith LK, Van Voorhees L, Gourley LA, Jolly MK (1993) Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. N Engl J Med 329:1–7
Uretsky BF, Young JB, Shahidi FE, Yellen LG, Harrison MC, Jolly MK (1993) Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: results of the PROVED Trial. J Am Coll Cardiol 22:955–962
The Digitalis Investigation Group (1997) The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 336:525–533
Packer M (1997) End of the oldest controversy in medicine. Are we ready to conclude the debate on digitalis? N Engl J Med 336:575–576
Packer M, Carver JR, Rodeheffer RJ, Ivanhoe RJ, DiBianco R, Zeldis SM, Hendrix GH, Bommer WJ, Elkayam U, Kukin ML, Mallis GI, Sollano JA, Shannon J, Tandon PK, DeMets DL (1991) Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group. N Engl J Med 325:1468–1475
Ahmed A, Pitt B, Rahimtoola SH, Waagstein F, White M, Love TE, Braunwald E (2008) Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: a propensity-matched study of the DIG trial. Int J Cardiol 123:138–146
We are indebt with the Health Council of the Junta de Andalucia and the “Plan Integral de Cardiopatías en Andalucía” (PICA) for the support of the registry. We are also grateful to the general secretariat of the virtual platform ARIAM-Andalucia, and to the Software Company Coresoft Clínico (http://www.coresoft.es). Without their help, this work would not have been possible.
Conflict of interest
On behalf of the ARIAM Andalucía Study Group, the list of investigators is given in ESM Appendix.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Garcia-Rubira, J.C., Calvo-Taracido, M., Francisco-Aparicio, F. et al. The previous use of digoxin does not worsen early outcome of acute coronary syndromes: an analysis of the ARIAM Registry. Intern Emerg Med 9, 759–765 (2014). https://doi.org/10.1007/s11739-013-1032-9
- Acute coronary syndrome
- Atrial fibrillation
- Heart failure
- Myocardial infarction