{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:29:37Z","timestamp":1791944977535,"version":"4.3.4"},"reference-count":22,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2018,8,1]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Digoxin is widely used in patients with rheumatic heart disease (RHD) despite a lack of data on its impact on clinical outcomes. We aimed to determine the association of digoxin use on clinical outcomes in patients with RHD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective analysis of the association of digoxin use with mortality at 2 years in a large RHD registry. Secondary outcomes were recurrent heart failure (HF) and hospitalisation for any cause. We assessed associations using multivariable logistic regression in the entire cohort and in subgroups of patients with atrial fibrillation (AF) and HF. We also estimated average treatment effects from propensity-adjusted analyses using inverse probability treatment weighting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Information on digoxin use at baseline was available for 98.7% (3298\/3343) of patients. In the overall population, digoxin was significantly associated with mortality (OR 1.63, 95%\u2009CI 1.30 to 2.04, p&lt;0.0001) and recurrent HF (OR 1.48, 95%\u2009CI 1.07 to 2.04, p=0.019). On propensity-weighted analyses, this effect was markedly attenuated (OR 1.05, 95%\u2009CI 1.01 to 1.09, p=0.005). Patients in sinus rhythm without HF had a higher propensity-adjusted odds of death with digoxin use (OR 1.06, 95%\u2009CI 1.01 to 1.12, p=0.015), but those with both AF and HF had lower mortality (OR 0.88, 95%\u2009CI 0.80 to 0.98, p=0.019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Digoxin use is associated with higher mortality in patients with RHD, but this is greatly attenuated on propensity adjustment, indicating the presence of substantial treatment bias. The adjusted estimates may therefore not be reliable, and large randomised trials are needed to determine the true effect of digoxin in patients with RHD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heartjnl-2018-313614","type":"journal-article","created":{"date-parts":[[2018,9,12]],"date-time":"2018-09-12T12:19:25Z","timestamp":1536754765000},"page":"363-369","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Digoxin and clinical outcomes in the Global Rheumatic Heart Disease Registry"],"prefix":"10.1136","volume":"105","author":[{"given":"Ganesan","family":"Karthikeyan","sequence":"first","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niveditha","family":"Devasenapathy","sequence":"additional","affiliation":[{"name":"Indian Institute of Public Health, Gurgaon, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liesl","family":"Z\u00fchlke","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Red Cross War Memorial Children\u2019s Hospital and University of Cape Town, Cape Town, South Africa"},{"name":"Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark Emmanuel","family":"Engel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumathy","family":"Rangarajan","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koon K","family":"Teo","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bongani M","family":"Mayosi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Yusuf","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,9,12]]},"reference":[{"key":"2025092002004509000_105.5.363.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603693"},{"key":"2025092002004509000_105.5.363.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu449"},{"key":"2025092002004509000_105.5.363.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024769"},{"key":"2025092002004509000_105.5.363.4","first-page":"e521","article-title":"AHA\/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice 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of rate versus rhythm in rheumatic atrial fibrillation: a randomized study","volume":"56","author":"Vora","year":"2004","journal-title":"Indian Heart J"},{"key":"2025092002004509000_105.5.363.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.01.013"},{"key":"2025092002004509000_105.5.363.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h4451"},{"key":"2025092002004509000_105.5.363.18","doi-asserted-by":"crossref","first-page":"ehw577","DOI":"10.1093\/eurheartj\/ehw577","article-title":"Assumption versus evidence: the case of digoxin in atrial fibrillation and heart failure","volume":"38","author":"Bavendiek","year":"2017","journal-title":"Eur Heart J"},{"key":"2025092002004509000_105.5.363.19","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1161\/01.CIR.73.1.14","article-title":"Digitalis--a new controversy regarding an old drug. The pitfalls of inappropriate methods","volume":"73","author":"Yusuf","year":"1986","journal-title":"Circulation"},{"key":"2025092002004509000_105.5.363.20","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-007-0346-9"},{"key":"2025092002004509000_105.5.363.21","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs348"},{"key":"2025092002004509000_105.5.363.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.12.060"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2018-313614","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T09:00:58Z","timestamp":1758358858000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2018-313614"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,12]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,2,12]]},"published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1136\/heartjnl-2018-313614"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2018-313614","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,12]]}}}