000			03735nam a22006017a 4500
008			190724s20192019 xxu||||| |||| 00| 0 eng d
022			_a0002-9343
024			_a10.1016/j.amjmed.2019.05.012 [doi]
024			_aS0002-9343(19)30443-7 [pii]
040			_aOvid MEDLINE(R)
099			_a31150644
245			_aDigoxin Use and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction.
251			_aAmerican Journal of Medicine. 132(11):1311-1319, 2019 11.
252			_aAm J Med. 132(11):1311-1319, 2019 11.
252			_zAm J Med. 2019 May 29
253			_aThe American journal of medicine
260			_c2019
260			_fFY2020
265			_saheadofprint
265			_sppublish
266			_d2019-06-21
268			_aAmerican Journal of Medicine. 2019 May 29
269			_fFY2019
501			_aAvailable online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present
520			_aBACKGROUND: 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.
520			_aCONCLUSIONS: 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.
520			_aCopyright Published by Elsevier Inc.
520			_aMETHODS: 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.
520			_aRESULTS: 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.
546			_aEnglish
650			_a*Cardiotonic Agents/tu [Therapeutic Use]
650			_a*Digoxin/tu [Therapeutic Use]
650			_a*Heart Failure/dt [Drug Therapy]
650			_a*Hospitalization
650			_aAged
650			_aCause of Death
650			_aFemale
650			_aHeart Failure/mo [Mortality]
650			_aHumans
650			_aMale
650			_aMedicare
650			_aPatient Readmission/sn [Statistics & Numerical Data]
650			_aPropensity Score
650			_aStroke Volume
650			_aUnited States
651			_aMedStar Heart & Vascular Institute
657			_aJournal Article
700			_aBayoumi, Essraa
700			_aLam, Phillip H
790			_aAbdelmawgoud A, Ahmed A, Allman RM, Bayoumi E, Fonarow GC, Kanonidis IE, Lam PH, Malik A, Morgan CJ, Packer M, Qamer SZ, Singh S
856			_uhttps://dx.doi.org/10.1016/j.amjmed.2019.05.012 _zhttps://dx.doi.org/10.1016/j.amjmed.2019.05.012
942			_cART _dArticle
999			_c4305 _d4305