Tracy E. Macaulay, PharmD, AACC, BCPS-AQ Cardiology

Although digoxin has a very long clinical history, no randomized controlled trial has evaluated the use of digoxin for atrial fibrillation (AF). Therefore, the evidence for its use in AF is based on post hoc analyses of RCTs or on findings from observational studies. Several studies have shown the association of digoxin use with increased mortality rates. However, other studies have reported the opposite conclusions, and it remains controversial whether digoxin use is associated with increased mortality in patients with AF.

In pulmonary arterial hypertension patients, riociguat serves as a reasonable first-line alternative to PDE-5 inhibitors or in combination therapy with an endothelin antagonist or inhaled prostacyclin analogues.