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Randomized Controlled Trial
. 2018 Mar;41(3):406-412.
doi: 10.1002/clc.22889. Epub 2018 Mar 22.

Digoxin use and lower risk of 30-day all-cause readmission in older patients with heart failure and reduced ejection fraction receiving β-blockers

Phillip H Lam  1   2 , Poonam Bhyan  1   2 , Cherinne Arundel  1   3 , Daniel J Dooley  1   2 , Helen M Sheriff  1   3 , Selma F Mohammed  4 , Gregg C Fonarow  5 , Charity J Morgan  6 , Wilbert S Aronow  7 , Richard M Allman  8 , Finn Waagstein  9 , Ali Ahmed  1   3
Affiliations
Randomized Controlled Trial

Digoxin use and lower risk of 30-day all-cause readmission in older patients with heart failure and reduced ejection fraction receiving β-blockers

Phillip H Lam et al. Clin Cardiol. 2018 Mar.

Abstract

Background: Digoxin use has been associated with a lower risk of 30-day all-cause admission and readmission in patients with heart failure and reduced ejection fraction (HFrEF).

Hypothesis: Digoxin use will be associated with improved outcomes in patients with HFrEF receiving β-blockers.

Methods: Of the 3076 hospitalized Medicare beneficiaries with HFrEF (EF <45%), 1046 received a discharge prescription for β-blockers, of which 634 were not on digoxin. Of the 634, 204 received a new discharge prescription for digoxin. Propensity scores for digoxin use, estimated for each of the 634 patients, were used to assemble a matched cohort of 167 pairs of patients receiving and not receiving digoxin, balanced on 30 baseline characteristics. Matched patients (n = 334) had a mean age of 74 years and were 46% female and 30% African American.

Results: 30-day all-cause readmission occurred in 15% and 27% of those receiving and not receiving digoxin, respectively (hazard ratio [HR]: 0.51, 95% confidence interval [CI]: 0.31-0.83, P = 0.007). This beneficial association persisted during 4 years of follow-up (HR: 0.72, 95% CI: 0.57-0.92, P = 0.008). Digoxin use was also associated with a lower risk of the combined endpoint of all-cause readmission or all-cause mortality at 30 days (HR: 0.54, 95% CI: 0.34-0.86, P = 0.009) and at 4 years (HR: 0.76, 95% CI: 0.61-0.96, P = 0.020).

Conclusions: In hospitalized patients with HFrEF receiving β-blockers, digoxin use was associated with a lower risk of 30-day all-cause readmission but not mortality, which persisted during longer follow-up.

Keywords: Digoxin; Heart Failure; Hospital Readmission; β-Blockers.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart displaying assembly of matched cohort of patients with HFrEF on β‐blockers eligible for new digoxin therapy. Abbreviations: HFrEF, heart failure with reduced ejection fraction
Figure 2
Figure 2
Love plot displaying absolute standardized differences comparing 30 baseline characteristics between hospitalized patients with HFrEF on β‐blockers receiving and not receiving a new discharge prescription for digoxin, before and after propensity‐score matching. Abbreviations: ACE, angiotensin‐converting enzyme; ARBs, angiotensin II receptor blockers; HFrEF, heart failure with reduced ejection fraction
Figure 3
Figure 3
Kaplan–Meier plots for combined endpoint of all‐cause readmission or all‐cause mortality by a new discharge prescription for digoxin in a propensity score–matched cohort of hospitalized patients with HFrEF on β‐blockers. Abbreviations: CI, confidence interval; HFrEF, heart failure with reduced ejection fraction; HR, hazard ratio
See this image and copyright information in PMC

References

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