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Randomized Controlled Trial
. 2007 Mar;62(3):323-9.
doi: 10.1093/gerona/62.3.323.

Digoxin and reduction in mortality and hospitalization in geriatric heart failure: importance of low doses and low serum concentrations

Ali Ahmed  1
Affiliations
Randomized Controlled Trial

Digoxin and reduction in mortality and hospitalization in geriatric heart failure: importance of low doses and low serum concentrations

Ali Ahmed. J Gerontol A Biol Sci Med Sci. 2007 Mar.

Abstract

Background: Digoxin reduces hospitalizations due to heart failure (HF) and may also reduce mortality at low serum digoxin concentrations (SDC). Most HF patients are > or = 65 years, yet the effects of digoxin on outcomes in these patients have not been well studied.

Methods: Of the 7788 ambulatory chronic HF patients in normal sinus rhythm in the Digitalis Investigation Group trial (1991-1995), 5548 (2890 were > or = 65 years) were alive at 1 month and were either receiving placebo or had data on SDC. Of these patients, 982 had low (0.5-0.9 ng/mL) and 705 had high (> or = 1 ng/mL) SDC.

Results: Among patients > or = 65 years, compared with 38% placebo patients, 34% low SDC patients died during 39 months of median follow-up (adjusted hazard ratio [AHR] = 0.81; 95% confidence interval [CI] = 0.68-0.96; p =.017). All-cause hospitalizations occurred in 70% of placebo and 68% of low-SDC patients (AHR = 0.86; 95% CI = 0.76-0.98; p =.019). Reduction in hospitalizations for HF occurred in both low and high SDC groups. High SDC was not independently associated with all-cause hospitalization or all-cause mortality. Age, impaired renal function, and pulmonary congestion reduced the odds of low SDC. Low-dose digoxin (< or = 0.125 mg/d) was the strongest independent predictor of low SDC (adjusted odd ratio = 2.37; 95% CI = 1.65-3.39); p <.0001).

Conclusions: Digoxin at low SDC was associated with a reduction in mortality and hospitalization in chronic geriatric HF, and low-dose digoxin was the strongest predictor of low SDC.

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Figures

Figure 1
Figure 1
Kaplan Meier plots for all-cause mortality in heart failure patients (a) < 65 years and (b) ≥ 65 years
Figure 2
Figure 2
Kaplan Meier plots for hospitalization due to worsening heart failure in patients (a) <65 years and (b) ≥ 65 years
Figure 3
Figure 3
Independent predictors of low (0.5 – 0.9 ng/ml) serum digoxin concentrations among patients < 65 years (left panel: n=806; median age, 58 years) and ≥ 65 years (right panel: n=881; median age, 72 years) [Chronic kidney disease=estimated glomerular filtration rate <60 ml/m/1.73 square meters; OR=odds ratio, CI=confidence interval
See this image and copyright information in PMC

References

    1. American Heart Association. Heart Disease and Stroke Statistics: 2005 Update. Dallas, TX: American Heart Association; 2005.
    1. The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525–533. - PubMed
    1. Rich MW, McSherry F, Williford WO, Yusuf S. Effect of age on mortality, hospitalizations and response to digoxin in patients with heart failure: the DIG study. J Am Coll Cardiol. 2001;38:806–813. - PubMed
    1. Ahmed A, Rich MW, Love TE, et al. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J. 2006;27:178–186. - PMC - PubMed
    1. Brophy JM. Rehabilitating digoxin. Eur Heart J. 2006;27:127–129. - PubMed

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