Digoxin use and lower risk of 30-day all-cause readmission in older patients with heart failure and reduced ejection fraction receiving beta-blockers.
Citation: Clinical Cardiology. 41(3):406-412, 2018 Mar.PMID: 29569405Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Medicine/Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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]Year: 2018Local holdings: Available online from MWHC library: 1976 - present, Available in print through MWHC library:1999-2007ISSN:- 0160-9289
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 29569405 | Available | 29569405 |
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).
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