Contemporary utilization of digoxin in patients with atrial fibrillation

OBJECTIVE: TO define the contemporary practice patterns of digoxin utilizat ion for the management of patients with atrial fibrillation (AF). METHODS: A retrospective medical records audit of 2490 patients with docume nted AF, from 12 Canadian hospitals and six outpatient clinics, during fisc al year 1993-1994, was conducted. RESULTS:There were 1158 women and 1332 men, with a mean age of 72 years; 95 6 patients were <70 years of age and 1534 were greater than or equal to 70 years old. The majority of patients had nonvalvular AF (75% of those with a documented etiology). Paroxysmal AF (PAF) was documented in 800 patients, 936 had chronic AF, and 754 had new-onset AF. While the prescribing pattern s were heterogeneous, the predominant strategy pursued in all subgroups app eared to be that of achieving rate control. Digoxin was the most commonly p rescribed medication (79%) and was prescribed for the majority of patients in all subgroups, including patients with PAF (74%) and patients with a his tory of chronic AF who were currently in sinus rhythm (83%). Only 10% of th e patients with PAF who were prescribed digoxin had congestive heart failur e. Similarly, less than 25% of the patients with chronic AF who were prescr ibed digoxin after conversion to sinus rhythm had evidence of heart failure , CONCLUSIONS: In the absence of clinical trial evidence supporting either a strategy of antiarrhythmic therapy or rate control with anticoagulation, th e appropriateness of the observed prescribing practices cannot be judged, H owever, digoxin is not the best rate-controlling agent for all patients and may be overused in certain subgroups of patients, such as those with PAF a nd those successfully converted to sinus rhythm.