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Despite that AFFIRM was ostensibly a study designed to look at the effect of rate control vs rhythm control in treating atrial fibrillation, the use of digoxin increased all-cause mortality by a statistically significant 41% compared to those who did not receive digoxin, regardless of whether they received an ACE inhibitor, amiodarone, beta blocker, and/or cardioversion.
Now atrial fibrillation has also been associated with heart failure so an analysis was also performed looking at the effect of digoxin on heart failure mortality. The authors concluded that use of digoxin in the setting of atrial fibrillation w/o heart failure led to a statistically significant 37% increase in all-cause mortality compared to someone who did not receive digoxin. In someone w/both atrial fibrillation & heart failure, use of digoxin increased all-cause mortality by 41%.
So what do we do with this information? Ignore it and sweep it under the proverbial rug? Or press forward with new studies to (dis)prove these findings. Is this a fluke or start of a trend? Fear of the unknown is what holds back progress. Follow @alvinblin  
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