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Digoxin Initiation and Outcomes in Patients with Heart Failure (HFrEF and HFpEF) and Atrial Fibrillation.

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Citation: American Journal of Medicine. 133(12):1460-1470, 2020 12.PMID: 32603789Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Atrial Fibrillation/dt [Drug Therapy] | *Cardiotonic Agents/tu [Therapeutic Use] | *Digoxin/tu [Therapeutic Use] | *Heart Failure/dt [Drug Therapy] | Aged | Aged, 80 and over | Female | Humans | Male | Retrospective Studies | Treatment OutcomeYear: 2020 ISSN:

0002-9343

Name of journal: The American journal of medicineAbstract: BACKGROUND: Digoxin reduces the risk of heart failure hospitalization but has no effect on mortality in patients with heart failure without atrial fibrillation in the randomized controlled trial setting. Observational studies of digoxin use in patients with atrial fibrillation have suggested a higher risk for poor outcomes. Less is known about this association in patients with heart failure and atrial fibrillation, the examination of which was the objective of the current study.CONCLUSIONS: Among hospitalized older patients with HFrEF and HFpEF and atrial fibrillation, initiation of digoxin was associated with a lower risk of heart failure readmission but had no association with mortality. Copyright (c) 2020. Published by Elsevier Inc.METHODS: We conducted an observational propensity score-matched study of pre-discharge digoxin initiation in 1768 hospitalized patients with heart failure and atrial fibrillation in Medicare-linked OPTIMIZE-HF registry, balanced on 56 baseline characteristics (mean age, 79 years; 55% women; 7% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes were estimated for the 884 patients initiated on digoxin compared with 884 not initiated on digoxin.RESULTS: HRs (95% CIs) for 30-day, 2-year, and 4-year all-cause mortality were 0.80 (0.55-1.18; p=0.261), 0.94 (0.87-1.16; p=0.936), and 1.01 (0.90- 1.14; p=0.729), respectively. Respective HRs (95% CIs) for heart failure readmission were 0.67 (0.49-0.92; p=0.014), 0.81 (0.69-0.94; p=0.005), and 0.85 (0.74-0.97; p=0.022), and those for all-cause readmission were 0.78 (0.64-0.96; p=0.016), 0.90 (0.81-1.00; p=0.057), and 0.91 (0.83-1.01; p=0.603). These associations were homogeneous between patients with left ventricular ejection fraction <=45% versus >45%.All authors: Ahmed A, Allman RM, Anker MS, Arundel C, Deedwania P, Faselis C, Fonarow GC, Karasik PA, Lam PH, Moore H, Morgan CJ, Singh S, Tummala L, Wopperer S, Zeng QOriginally published: American Journal of Medicine. 2020 Jun 27Fiscal year: FY2021Digital Object Identifier:

https://dx.doi.org/10.1016/j.amjmed.2020.05.030

Date added to catalog: 2020-08-26

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	32603789	Available		32603789

BACKGROUND: Digoxin reduces the risk of heart failure hospitalization but has no effect on mortality in patients with heart failure without atrial fibrillation in the randomized controlled trial setting. Observational studies of digoxin use in patients with atrial fibrillation have suggested a higher risk for poor outcomes. Less is known about this association in patients with heart failure and atrial fibrillation, the examination of which was the objective of the current study.

CONCLUSIONS: Among hospitalized older patients with HFrEF and HFpEF and atrial fibrillation, initiation of digoxin was associated with a lower risk of heart failure readmission but had no association with mortality. Copyright (c) 2020. Published by Elsevier Inc.

METHODS: We conducted an observational propensity score-matched study of pre-discharge digoxin initiation in 1768 hospitalized patients with heart failure and atrial fibrillation in Medicare-linked OPTIMIZE-HF registry, balanced on 56 baseline characteristics (mean age, 79 years; 55% women; 7% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes were estimated for the 884 patients initiated on digoxin compared with 884 not initiated on digoxin.

RESULTS: HRs (95% CIs) for 30-day, 2-year, and 4-year all-cause mortality were 0.80 (0.55-1.18; p=0.261), 0.94 (0.87-1.16; p=0.936), and 1.01 (0.90- 1.14; p=0.729), respectively. Respective HRs (95% CIs) for heart failure readmission were 0.67 (0.49-0.92; p=0.014), 0.81 (0.69-0.94; p=0.005), and 0.85 (0.74-0.97; p=0.022), and those for all-cause readmission were 0.78 (0.64-0.96; p=0.016), 0.90 (0.81-1.00; p=0.057), and 0.91 (0.83-1.01; p=0.603). These associations were homogeneous between patients with left ventricular ejection fraction <=45% versus >45%.

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