TY  - BOOK
AU  - Lam, Phillip H
TI  - Digoxin Initiation and Outcomes in Patients with Heart Failure (HFrEF and HFpEF) and Atrial Fibrillation
SN  - 0002-9343
PY  - 2020///
KW  - *Atrial Fibrillation/dt [Drug Therapy]
KW  - *Cardiotonic Agents/tu [Therapeutic Use]
KW  - *Digoxin/tu [Therapeutic Use]
KW  - *Heart Failure/dt [Drug Therapy]
KW  - Aged
KW  - Aged, 80 and over
KW  - Female
KW  - Humans
KW  - Male
KW  - Retrospective Studies
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N2  - 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%
UR  - https://dx.doi.org/10.1016/j.amjmed.2020.05.030
ER  -