Abstract

Background: The application of digoxin in treating patients with heart failure (HF) has been lasted for more than 200 years, however, controversies remain on the effectiveness and safety of digoxin in prognosis of HF patients. Thus, we performed this meta-analysis of clinical trials that examined the digoxin use to evaluate effectiveness and safety.

Methods and Result: We searched for the cohort studies that investigated the effect of the digoxin on prognosis of the patients with HF in MEDLINE, EMBASE, Chinese National Knowledge Infrastructure (CNKI), and which were published between January 1993 and October 2013. The outcomes of interest comprised all-cause mortality, HF hospitalization and all-cause hospitalization. In addition, pooled hazard risks (HRs) and 95% confidence intervals (CIs) were calculated to assess the effectiveness and safety of digoxin for HF. Nine cohort studies were retrieved from 1431 citation for the analysis, and in total, 84,692 patients were included in the analysis. After synthesizing data, the meta-analysis showed significant increasing of all cause mortality (HR=1.15, 95%CI=1.04-1.27, p<0.001) in the patients with digoxin treatment compared to the controls, whereas no significant difference was found on HF hospitalization (HR=1.06, 95%CI=0.784-1.431, p<0.001) and all cause hospitalization (HR=0.988, 95%CI=0.720-1.354). Moreover, no altered overall results were found after sensitivity analysis.

Conclusion: Therefore, according to the results of our meta-analysis, the use of digoxin could significantly increase the risk of all cause mortality. However, no effect on the HF hospitalization and all-cause hospitalization was found.

Keywords: Meta-analysis, cohort studies, digoxin, heart failure, mortality, hospitalization.

Graphical Abstract