Digoxin Use and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction |
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| Affiliation: | 1. Veterans Affairs Medical Center, Washington, DC;2. Georgetown University, Washington, DC;3. MedStar Washington Hospital Center, Washington, DC;4. Baylor University Medical Center, Dallas, TX;5. Aristotle University, Thessaloniki, Greece;6. University of Alabama at Birmingham;7. Ain Shams University, Cairo, Egypt;8. George Washington University, Washington, DC;9. University of California, Los Angeles;1. Department of Medicine, Division of Pulmonary and Critical Care Medicine;2. Department of Pathology, Albany Medical College, NY;1. Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anshutz Medical Campus, Aurora, Colo;2. University of Washington, Pulmonary Critical Care and Sleep Medicine, Medical Service, VA Puget Sound Health Care System, Seattle;3. Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo;1. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City;2. Division of Neurointerventional Radiology, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City;1. Division of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, Albuquerque;2. Department of Internal Medicine, Division of Rheumatology, Raymond G. Murphy VA Medical Center, Albuquerque, NM;1. Procedure Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif;2. Procedure Center, Department of Medicine, Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif |
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| Abstract: | BackgroundHeart failure is a leading cause for hospital readmission. Digoxin use may lower this risk in patients with heart failure with reduced ejection fraction (HFrEF), but data on contemporary patients receiving other evidence-based therapies are lacking.MethodsOf the 11,900 patients with HFrEF (ejection fraction ≤ 45%) in Medicare-linked OPTIMIZE-HF, 8401 were not on digoxin, of whom 1571 received discharge prescriptions for digoxin. We matched 1531 of these patients with 1531 not receiving digoxin by propensity scores for digoxin use. The matched cohort (n = 3062; mean age, 76 years; 44% women; 14% African American) was balanced on 52 baseline characteristics. We assembled a second matched cohort of 2850 patients after excluding those with estimated glomerular filtration rate < 15 mL/min/1.73 m2 and heart rate < 60 beats/min. Hazard ratios (HRs) and 95% confidence intervals (CIs) for digoxin-associated outcomes were estimated in the matched cohorts.ResultsAmong the 3062 matched patients, digoxin use was associated with a significantly lower risk of heart failure readmission at 30 days (HR, 0.74; 95% CI, 0.59-0.93), 1 year (HR, 0.81; 95% CI, 0.72-0.92), and 6 years (HR, 0.90; 95% CI 0.81-0.99). The association with all-cause readmission was significant at 1 and 6 years but not 30 days. There was no association with mortality. Similar associations were observed among the 2850 matched patients without bradycardia or renal insufficiency.ConclusionsAmong hospitalized older patients with HFrEF receiving contemporary treatments for heart failure, digoxin use is associated with a lower risk of hospital readmission but not all-cause mortality. |
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