Digoxin and amiodarone on the risk of ischemic stroke in atrial fibrillation: An observational study

Kuan Cheng Lai, Sy Jou Chen, Chin Sheng Lin, Fu Chi Yang, Cheng Li Lin, Chin Wang Hsu, Wen Chen Huang, Chia Hung Kao

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: The present study compared the risk of ischemic stroke in atrial fibrillation (AF) patients receiving digoxin and amiodarone. Methods: A retrospective cohort study was conducted using the longitudinal population-based database of Taiwan's National Health Insurance program. Patients with AF who received amiodarone or digoxin and were considered to have exposed to study drugs consecutively over 180 days during 2000-2010 were enrolled and divided into three groups: those who received amiodarone, digoxin, and amiodarone plus digoxin. All patients were followed from the index date to the occurrence of ischemic stroke, death, withdrawal from the insurance program, or December 31, 2011. Cox proportional hazard regression models were applied to determine the risk of ischemic stroke and associated risk factors. Results: The amiodarone, digoxin, and amiodarone plus digoxin cohorts comprised 797, 1419, and 376 patients, respectively. Overall, the patients who received digoxin (HR = 1.80; 95% CI = 1.41-2.31) or amiodarone plus digoxin (HR = 2.00; 95% CI = 1.49-2.68) had a higher risk of ischemic stroke, compared with those who received amiodarone. This risk was particularly at CHA2DS2VASc score of 2-5, but disappeared in those who received clopidogrel in the digoxin cohort. The risk of ischemic stroke in the amiodarone plus digoxin cohort did not differ significantly from that in the digoxin cohort (HR = 1.14; 95% CI = 0.90-1.44). Conclusion: Atrial fibrillation patients receiving digoxin are associated with a higher risk of ischemic stroke than are those receiving amiodarone. It is prudent to assess the stroke risk prior to applying treatment strategy for patients with AF. Strengths and Limitations of This Study - This study is a population-based design with a completeness and accuracy of data, national coverage in both study and control cohorts. All insurance claims were double-checked by medical specialists for peer review. - Information about serum levels of the drugs, coagulation status, and types of AF were unavailable in this administrative database.

Original languageEnglish
Article number448
JournalFrontiers in Pharmacology
Volume9
Issue numberMAY
DOIs
Publication statusPublished - May 7 2018

Fingerprint

Amiodarone
Digoxin
Atrial Fibrillation
Observational Studies
Stroke
clopidogrel
National Health Programs
Insurance
Cohort Studies
Databases
Peer Review
Taiwan
Proportional Hazards Models
Pharmaceutical Preparations
Population
Retrospective Studies

Keywords

  • Amiodarone
  • Atrial fibrillation
  • Cohort study
  • Digoxin
  • Ischemic stroke

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Digoxin and amiodarone on the risk of ischemic stroke in atrial fibrillation : An observational study. / Lai, Kuan Cheng; Chen, Sy Jou; Lin, Chin Sheng; Yang, Fu Chi; Lin, Cheng Li; Hsu, Chin Wang; Huang, Wen Chen; Kao, Chia Hung.

In: Frontiers in Pharmacology, Vol. 9, No. MAY, 448, 07.05.2018.

Research output: Contribution to journalArticle

Lai, Kuan Cheng ; Chen, Sy Jou ; Lin, Chin Sheng ; Yang, Fu Chi ; Lin, Cheng Li ; Hsu, Chin Wang ; Huang, Wen Chen ; Kao, Chia Hung. / Digoxin and amiodarone on the risk of ischemic stroke in atrial fibrillation : An observational study. In: Frontiers in Pharmacology. 2018 ; Vol. 9, No. MAY.
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abstract = "Purpose: The present study compared the risk of ischemic stroke in atrial fibrillation (AF) patients receiving digoxin and amiodarone. Methods: A retrospective cohort study was conducted using the longitudinal population-based database of Taiwan's National Health Insurance program. Patients with AF who received amiodarone or digoxin and were considered to have exposed to study drugs consecutively over 180 days during 2000-2010 were enrolled and divided into three groups: those who received amiodarone, digoxin, and amiodarone plus digoxin. All patients were followed from the index date to the occurrence of ischemic stroke, death, withdrawal from the insurance program, or December 31, 2011. Cox proportional hazard regression models were applied to determine the risk of ischemic stroke and associated risk factors. Results: The amiodarone, digoxin, and amiodarone plus digoxin cohorts comprised 797, 1419, and 376 patients, respectively. Overall, the patients who received digoxin (HR = 1.80; 95{\%} CI = 1.41-2.31) or amiodarone plus digoxin (HR = 2.00; 95{\%} CI = 1.49-2.68) had a higher risk of ischemic stroke, compared with those who received amiodarone. This risk was particularly at CHA2DS2VASc score of 2-5, but disappeared in those who received clopidogrel in the digoxin cohort. The risk of ischemic stroke in the amiodarone plus digoxin cohort did not differ significantly from that in the digoxin cohort (HR = 1.14; 95{\%} CI = 0.90-1.44). Conclusion: Atrial fibrillation patients receiving digoxin are associated with a higher risk of ischemic stroke than are those receiving amiodarone. It is prudent to assess the stroke risk prior to applying treatment strategy for patients with AF. Strengths and Limitations of This Study - This study is a population-based design with a completeness and accuracy of data, national coverage in both study and control cohorts. All insurance claims were double-checked by medical specialists for peer review. - Information about serum levels of the drugs, coagulation status, and types of AF were unavailable in this administrative database.",
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AU - Lai, Kuan Cheng

AU - Chen, Sy Jou

AU - Lin, Chin Sheng

AU - Yang, Fu Chi

AU - Lin, Cheng Li

AU - Hsu, Chin Wang

AU - Huang, Wen Chen

AU - Kao, Chia Hung

PY - 2018/5/7

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N2 - Purpose: The present study compared the risk of ischemic stroke in atrial fibrillation (AF) patients receiving digoxin and amiodarone. Methods: A retrospective cohort study was conducted using the longitudinal population-based database of Taiwan's National Health Insurance program. Patients with AF who received amiodarone or digoxin and were considered to have exposed to study drugs consecutively over 180 days during 2000-2010 were enrolled and divided into three groups: those who received amiodarone, digoxin, and amiodarone plus digoxin. All patients were followed from the index date to the occurrence of ischemic stroke, death, withdrawal from the insurance program, or December 31, 2011. Cox proportional hazard regression models were applied to determine the risk of ischemic stroke and associated risk factors. Results: The amiodarone, digoxin, and amiodarone plus digoxin cohorts comprised 797, 1419, and 376 patients, respectively. Overall, the patients who received digoxin (HR = 1.80; 95% CI = 1.41-2.31) or amiodarone plus digoxin (HR = 2.00; 95% CI = 1.49-2.68) had a higher risk of ischemic stroke, compared with those who received amiodarone. This risk was particularly at CHA2DS2VASc score of 2-5, but disappeared in those who received clopidogrel in the digoxin cohort. The risk of ischemic stroke in the amiodarone plus digoxin cohort did not differ significantly from that in the digoxin cohort (HR = 1.14; 95% CI = 0.90-1.44). Conclusion: Atrial fibrillation patients receiving digoxin are associated with a higher risk of ischemic stroke than are those receiving amiodarone. It is prudent to assess the stroke risk prior to applying treatment strategy for patients with AF. Strengths and Limitations of This Study - This study is a population-based design with a completeness and accuracy of data, national coverage in both study and control cohorts. All insurance claims were double-checked by medical specialists for peer review. - Information about serum levels of the drugs, coagulation status, and types of AF were unavailable in this administrative database.

AB - Purpose: The present study compared the risk of ischemic stroke in atrial fibrillation (AF) patients receiving digoxin and amiodarone. Methods: A retrospective cohort study was conducted using the longitudinal population-based database of Taiwan's National Health Insurance program. Patients with AF who received amiodarone or digoxin and were considered to have exposed to study drugs consecutively over 180 days during 2000-2010 were enrolled and divided into three groups: those who received amiodarone, digoxin, and amiodarone plus digoxin. All patients were followed from the index date to the occurrence of ischemic stroke, death, withdrawal from the insurance program, or December 31, 2011. Cox proportional hazard regression models were applied to determine the risk of ischemic stroke and associated risk factors. Results: The amiodarone, digoxin, and amiodarone plus digoxin cohorts comprised 797, 1419, and 376 patients, respectively. Overall, the patients who received digoxin (HR = 1.80; 95% CI = 1.41-2.31) or amiodarone plus digoxin (HR = 2.00; 95% CI = 1.49-2.68) had a higher risk of ischemic stroke, compared with those who received amiodarone. This risk was particularly at CHA2DS2VASc score of 2-5, but disappeared in those who received clopidogrel in the digoxin cohort. The risk of ischemic stroke in the amiodarone plus digoxin cohort did not differ significantly from that in the digoxin cohort (HR = 1.14; 95% CI = 0.90-1.44). Conclusion: Atrial fibrillation patients receiving digoxin are associated with a higher risk of ischemic stroke than are those receiving amiodarone. It is prudent to assess the stroke risk prior to applying treatment strategy for patients with AF. Strengths and Limitations of This Study - This study is a population-based design with a completeness and accuracy of data, national coverage in both study and control cohorts. All insurance claims were double-checked by medical specialists for peer review. - Information about serum levels of the drugs, coagulation status, and types of AF were unavailable in this administrative database.

KW - Amiodarone

KW - Atrial fibrillation

KW - Cohort study

KW - Digoxin

KW - Ischemic stroke

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