Digoxin Initiation and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction.

MedStar author(s):
Citation: American Journal of Medicine. 133(10):1187-1194, 2020 10.PMID: 32272101Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Medicine/Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cardiotonic Agents/tu [Therapeutic Use] | *Digoxin/tu [Therapeutic Use] | *Heart Failure/dt [Drug Therapy] | *Mortality | *Patient Readmission/sn [Statistics & Numerical Data] | *Stroke Volume | Adrenergic beta-Antagonists/tu [Therapeutic Use] | Aged | Aged, 80 and over | Angiotensin Receptor Antagonists/tu [Therapeutic Use] | Angiotensin-Converting Enzyme Inhibitors/tu [Therapeutic Use] | Anti-Arrhythmia Agents/tu [Therapeutic Use] | Anticoagulants/tu [Therapeutic Use] | Atrial Fibrillation/dt [Drug Therapy] | Atrial Fibrillation/ep [Epidemiology] | Cause of Death | Female | Heart Failure/ep [Epidemiology] | Heart Failure/pp [Physiopathology] | Hospitalization | Humans | Hydroxymethylglutaryl-CoA Reductase Inhibitors/tu [Therapeutic Use] | Male | Mineralocorticoid Receptor Antagonists/tu [Therapeutic Use] | Platelet Aggregation Inhibitors/tu [Therapeutic Use] | Propensity Score | Proportional Hazards Models | Registries | Sodium Potassium Chloride Symporter Inhibitors/tu [Therapeutic Use] | Warfarin/tu [Therapeutic Use]Year: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - presentISSN:
  • 0002-9343
Name of journal: The American journal of medicineAbstract: BACKGROUND: Digoxin reduces the risk of heart failure hospitalization in patients with heart failure with reduced ejection fraction. Less is known about this association in patients with heart failure with preserved ejection fraction (HFpEF), the examination of which was the objective of the current study.CONCLUSION: Digoxin initiation prior to hospital discharge was not associated with 30-day or 6-year outcomes in older hospitalized patients with HFpEF. Copyright Published by Elsevier Inc.METHODS: In the Medicare-linked OPTIMIZE-HF registry, 7374 patients hospitalized for HF had ejection fraction >=50% and were not receiving digoxin prior to admission. Of these, 5675 had a heart rate >=50 beats per minute, an estimated glomerular filtration rate >=30 mL/min/1.73 m2 or did not receive inpatient dialysis, and digoxin was initiated in 524 of these patients. Using propensity scores for digoxin initiation, calculated for each of the 5675 patients, we assembled a matched cohort of 513 pairs of patients initiated and not initiated on digoxin, balanced on 58 baseline characteristics (mean age, 80 years; 66% women; 8% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin initiation were estimated in the matched cohort.RESULTS: Among the 1026 matched patients with HFpEF, 30-day heart failure readmission occurred in 6% and 9% of patients initiated and not initiated on digoxin, respectively (HR 0.70; 95% CI, 0.45-1.10; P = .124). HRs (95% CIs) for 30-day all-cause readmission and all-cause mortality associated with digoxin initiation were 0.95 (0.73-1.23; P = .689) and 0.93 (0.55-1.56; P = .773), respectively. Digoxin initiation had no association with 6-year outcomes.All authors: Ahmed A, Allman RM, Arundel C, Brar V, Cheng Y, Fonarow GC, Gill GS, Lam PH, Levy WC, Packer M, Singh SN, Wu WC, Zile MROriginally published: American Journal of Medicine. 2020 Apr 06Fiscal year: FY2021Fiscal year of original publication: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32272101 Available 32272101

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present

BACKGROUND: Digoxin reduces the risk of heart failure hospitalization in patients with heart failure with reduced ejection fraction. Less is known about this association in patients with heart failure with preserved ejection fraction (HFpEF), the examination of which was the objective of the current study.

CONCLUSION: Digoxin initiation prior to hospital discharge was not associated with 30-day or 6-year outcomes in older hospitalized patients with HFpEF. Copyright Published by Elsevier Inc.

METHODS: In the Medicare-linked OPTIMIZE-HF registry, 7374 patients hospitalized for HF had ejection fraction >=50% and were not receiving digoxin prior to admission. Of these, 5675 had a heart rate >=50 beats per minute, an estimated glomerular filtration rate >=30 mL/min/1.73 m2 or did not receive inpatient dialysis, and digoxin was initiated in 524 of these patients. Using propensity scores for digoxin initiation, calculated for each of the 5675 patients, we assembled a matched cohort of 513 pairs of patients initiated and not initiated on digoxin, balanced on 58 baseline characteristics (mean age, 80 years; 66% women; 8% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin initiation were estimated in the matched cohort.

RESULTS: Among the 1026 matched patients with HFpEF, 30-day heart failure readmission occurred in 6% and 9% of patients initiated and not initiated on digoxin, respectively (HR 0.70; 95% CI, 0.45-1.10; P = .124). HRs (95% CIs) for 30-day all-cause readmission and all-cause mortality associated with digoxin initiation were 0.95 (0.73-1.23; P = .689) and 0.93 (0.55-1.56; P = .773), respectively. Digoxin initiation had no association with 6-year outcomes.

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