Karthikeyan G, et al. - In this retrospective analysis of patients with rheumatic heart disease (RHD), researchers investigated how digoxin use impacts clinical outcomes, including mortality at 2 years in a large RHD registry. Participants were also examined for secondary outcomes that included recurrent heart failure (HF) and hospitalization for any cause. Using multivariable logistic regression, they evaluated correlations in the entire cohort and in subgroups of patients with atrial fibrillation (AF) and HF. They observed a higher mortality in relation to digoxin use in patients with RHD, but the presence of substantial treatment bias was suggested by a great decrease of this link on propensity adjustment. Therefore, possible non-reliability of the adjusted estimates was suggested.