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Randomized Controlled Trial
. 2013 Aug;126(8):701-8.
doi: 10.1016/j.amjmed.2013.02.001. Epub 2013 Mar 12.

Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure

Robert C Bourge  1 , Jerome L Fleg, Gregg C Fonarow, John G F Cleland, John J V McMurray, Dirk J van Veldhuisen, Mihai Gheorghiade, Kanan Patel, Inmaculada B Aban, Richard M Allman, Connie White-Williams, Michel White, Gerasimos S Filippatos, Stefan D Anker, Ali Ahmed
Affiliations
Randomized Controlled Trial

Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure

Robert C Bourge et al. Am J Med. 2013 Aug.

Abstract

Background: Heart failure is a leading cause of hospital admission and readmission in older adults. The new United States healthcare reform law has created provisions for financial penalties for hospitals with higher than expected 30-day all-cause readmission rates for hospitalized Medicare beneficiaries aged ≥65 years with heart failure. We examined the effect of digoxin on 30-day all-cause hospital admission in older patients with heart failure and reduced ejection fraction.

Methods: In the main Digitalis Investigation Group trial, 6800 ambulatory patients with chronic heart failure (ejection fraction ≤45%) were randomly assigned to digoxin or placebo. Of these, 3405 were aged ≥65 years (mean age, 72 years; 25% were women; 11% were nonwhite). The main outcome in the current analysis was 30-day all-cause hospital admission.

Results: In the first 30 days after randomization, all-cause hospitalization occurred in 5.4% (92/1693) and 8.1% (139/1712) of patients in the digoxin and placebo groups, respectively, (hazard ratio {HR} when digoxin was compared with placebo, 0.66; 95% confidence interval {CI}, 0.51-0.86; P=.002). Digoxin also reduced both 30-day cardiovascular (3.5% vs 6.5%; HR, 0.53; 95% CI, 0.38-0.72; P<.001) and heart failure (1.7 vs 4.2%; HR, 0.40; 95% CI, 0.26-0.62; P<.001) hospitalizations, with similar trends for 30-day all-cause mortality (0.7% vs 1.3%; HR, 0.55; 95% CI, 0.27-1.11; P=.096). Younger patients were at lower risk of events but obtained similar benefits from digoxin.

Conclusions: Digoxin reduces 30-day all-cause hospital admission in ambulatory older patients with chronic systolic heart failure. Future studies need to examine its effect on 30-day all-cause hospital readmission in hospitalized patients with acute heart failure.

Keywords: 30-day all-cause hospital admission; Digoxin; Heart failure.

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Figures

Figure 1
Figure 1
Kaplan-Meier plots for 30-day all-cause hospital admission by randomization to digoxin or placebo in the subset of 3405 ambulatory patients 65 years of age or older with chronic heart failure and reduced ejection fraction in the main Digitalis Investigation Group (DIG) trial
Figure 2
Figure 2
Effect of digoxin on 30-day all-cause hospital admission in subgroups of 3405 ambulatory older patients with chronic heart failure and reduced ejection fraction in the main Digitalis Investigation Group (DIG) trial
See this image and copyright information in PMC

Comment in

  • The reply.
    Ahmed A, Gheorghiade M, Fonarow GC. Ahmed A, et al. Am J Med. 2014 Mar;127(3):e13. doi: 10.1016/j.amjmed.2013.11.007. Epub 2013 Dec 8. Am J Med. 2014. PMID: 24321411 No abstract available.
  • The endless story of digitalis.
    Tavazzi L. Tavazzi L. Am J Med. 2014 Mar;127(3):e11. doi: 10.1016/j.amjmed.2013.08.026. Am J Med. 2014. PMID: 24560326 No abstract available.
  • Use of digoxin in chronic systolic heart failure in current era.
    Temtanakitpaisan Y, Kilari S, Damrongwatanasuk R. Temtanakitpaisan Y, et al. Am J Med. 2015 Jan;128(1):e17. doi: 10.1016/j.amjmed.2014.03.030. Am J Med. 2015. PMID: 25553632 No abstract available.
  • The reply.
    Ahmed A, Fonarow GC, Bourge RC. Ahmed A, et al. Am J Med. 2015 Jan;128(1):e19. doi: 10.1016/j.amjmed.2014.09.014. Am J Med. 2015. PMID: 25553633 No abstract available.

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