Digoxin and 30-Day All-Cause Readmission in Long-Term Care Residents Hospitalized for Heart Failure

Abstract

Background: Digoxin use has been shown to be associated with a lower risk of 30-day all-cause hospital readmissions in older patients with heart failure (HF). In the current study, we examined this association among long-term care (LTC) residents hospitalized for HF.

Methods: Of the 8049 Medicare beneficiaries discharged alive after hospitalization for HF from 106 Alabama hospitals, 545 (7%) were LTC residents, of which 227 (42%) received discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 545 patients, were used to assemble a matched cohort of 158 pairs of patients receiving and not receiving digoxin who were balanced on 29 baseline characteristics. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin among matched patients were estimated using Cox regression models.

Results: Matched patients (n = 316) had a mean age of 83 years, 74% were women, and 18% African American. Thirty-day all-cause readmission occurred in 21% and 20% of patients receiving and not receiving digoxin, respectively (HR, 1.02; 95% CI, 0.63-1.66). Digoxin had no association with all-cause mortality (HR, 0.90; 95% CI, 0.48-1.70), HF readmission (HR, 0.90; 95% CI, 0.38-2.12), or a combined endpoint of all-cause readmission or all-cause mortality (HR, 0.97; 95% CI, 0.65-1.45) at 30 days. These associations remained unchanged at 1 year postdischarge.

Conclusions: The lack of an association between digoxin and 30-day all-cause readmission in older nursing home residents hospitalized for HF is intriguing and needs to be interpreted with caution given the small sample size.

Keywords: Digoxin; heart failure; hospital readmission; nursing home.

Figure 1

Love plot displaying absolute standardized differences for 29 baseline characteristics between patients receiving and not receiving digoxin, before and after propensity score matching are indicated by blank circle and black diamond shapes; ACE= Angiotensin converting enzyme

Figure 2

Kaplan-Meier plots for the combined end point of 30-day all-cause hospital readmission or 30-day all-cause mortality in a propensity-matched cohort of older heart failure patients admitted from nursing homes receiving and not receiving a discharge prescription for digoxin (CI=confidence interval)