TY  - BOOK
AU  - Bayoumi, Essraa
AU  - Lam, Phillip H
TI  - Digoxin Use and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction
SN  - 0002-9343
PY  - 2019///
KW  - *Cardiotonic Agents/tu [Therapeutic Use]
KW  - *Digoxin/tu [Therapeutic Use]
KW  - *Heart Failure/dt [Drug Therapy]
KW  - *Hospitalization
KW  - Aged
KW  - Cause of Death
KW  - Female
KW  - Heart Failure/mo [Mortality]
KW  - Humans
KW  - Male
KW  - Medicare
KW  - Patient Readmission/sn [Statistics & Numerical Data]
KW  - Propensity Score
KW  - Stroke Volume
KW  - United States
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present
N2  - BACKGROUND: Heart 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; CONCLUSIONS: Among 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; Copyright Published by Elsevier Inc; METHODS: Of 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 m<sup>2</sup> and heart rate <60 beats/min. Hazard ratios (HRs) and 95% confidence intervals (CIs) for digoxin-associated outcomes were estimated in the matched cohorts; RESULTS: Among 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
UR  - https://dx.doi.org/10.1016/j.amjmed.2019.05.012
ER  -