Digoxin use and lower risk of 30-day all-cause readmission in older patients with heart failure and reduced ejection fraction receiving beta-blockers. - 2018

Available online from MWHC library: 1976 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Digoxin use has been associated with a lower risk of 30-day all-cause admission and readmission in patients with heart failure and reduced ejection fraction (HFrEF). CONCLUSIONS: In hospitalized patients with HFrEF receiving beta-blockers, digoxin use was associated with a lower risk of 30-day all-cause readmission but not mortality, which persisted during longer follow-up. Copyright (c) 2018 Wiley Periodicals, Inc. HYPOTHESIS: Digoxin use will be associated with improved outcomes in patients with HFrEF receiving beta-blockers. METHODS: Of the 3076 hospitalized Medicare beneficiaries with HFrEF (EF <45%), 1046 received a discharge prescription for beta-blockers, of which 634 were not on digoxin. Of the 634, 204 received a new discharge prescription for digoxin. Propensity scores for digoxin use, estimated for each of the 634 patients, were used to assemble a matched cohort of 167 pairs of patients receiving and not receiving digoxin, balanced on 30 baseline characteristics. Matched patients (n=334) had a mean age of 74years and were 46% female and 30% African American. RESULTS: 30-day all-cause readmission occurred in 15% and 27% of those receiving and not receiving digoxin, respectively (hazard ratio [HR]: 0.51, 95% confidence interval [CI]: 0.31-0.83, P=0.007). This beneficial association persisted during 4years of follow-up (HR: 0.72, 95% CI: 0.57-0.92, P=0.008). Digoxin use was also associated with a lower risk of the combined endpoint of all-cause readmission or all-cause mortality at 30days (HR: 0.54, 95% CI: 0.34-0.86, P=0.009) and at 4years (HR: 0.76, 95% CI: 0.61-0.96, P=0.020).


English

0160-9289


*Adrenergic beta-Antagonists/ad [Administration & Dosage]
*Digoxin/ad [Administration & Dosage]
*Heart Failure/dt [Drug Therapy]
*Heart Ventricles/pp [Physiopathology]
*Patient Readmission/td [Trends]
*Ventricular Function, Left/ph [Physiology]
Aged
Alabama/ep [Epidemiology]
Cardiotonic Agents/ad [Administration & Dosage]
Dose-Response Relationship, Drug
Drug Therapy, Combination
Echocardiography
Female
Follow-Up Studies
Heart Failure/mo [Mortality]
Heart Failure/pp [Physiopathology]
Heart Ventricles/de [Drug Effects]
Heart Ventricles/dg [Diagnostic Imaging]
Hospital Mortality/td [Trends]
Humans
Male
Propensity Score
Retrospective Studies
Survival Rate/td [Trends]
Time Factors
Ventricular Function, Left/de [Drug Effects]


MedStar Heart & Vascular Institute
MedStar Washington Hospital Center


Medicine/Internal Medicine


Journal Article