Digitalis-associated cardiac mortality after myocardial infarction

Abstract

The effect of digitalis therapy on 4-month posthospital cardiac mortality was investigated in 812 patients who survived the hospital phase of acute myocardial infraction. A stepwise multiple logistic regression analysis was used to identify variables associated with increased mortality and to adjust for differences in confounding variables between digitalis and nondigitalis patients. The major 4-month mortality (10 of 26 patients [38.5%]) occurred in digitalis-treated patients with congestive heart failure in the coronary care unit and complex ventricular premature depolarizations (VPDs) on the predischarge Holter recording. Logistic analyses that controlled for confounding variables indicated that digitalis use contributed to the increased mortality rate in this high-risk subset. The predicted mortality difference due to digitalis in patients with congestive heart failure and complex VPDs, adjusted for relevant nondigitalis risk factor variables, was 30% (90% confidence interval 18-42%). This retrospective study suggests that digitalis use increases the early posthospital mortality of myocardial infarction patients with combined electrical and mechanical dysfunction.