Digoxin Initiation and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction.
Digoxin Initiation and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction.
- 2020
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present
BACKGROUND: Digoxin reduces the risk of heart failure hospitalization in patients with heart failure with reduced ejection fraction. Less is known about this association in patients with heart failure with preserved ejection fraction (HFpEF), the examination of which was the objective of the current study. CONCLUSION: Digoxin initiation prior to hospital discharge was not associated with 30-day or 6-year outcomes in older hospitalized patients with HFpEF. Copyright Published by Elsevier Inc. METHODS: In the Medicare-linked OPTIMIZE-HF registry, 7374 patients hospitalized for HF had ejection fraction >=50% and were not receiving digoxin prior to admission. Of these, 5675 had a heart rate >=50 beats per minute, an estimated glomerular filtration rate >=30 mL/min/1.73 m2 or did not receive inpatient dialysis, and digoxin was initiated in 524 of these patients. Using propensity scores for digoxin initiation, calculated for each of the 5675 patients, we assembled a matched cohort of 513 pairs of patients initiated and not initiated on digoxin, balanced on 58 baseline characteristics (mean age, 80 years; 66% women; 8% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin initiation were estimated in the matched cohort. RESULTS: Among the 1026 matched patients with HFpEF, 30-day heart failure readmission occurred in 6% and 9% of patients initiated and not initiated on digoxin, respectively (HR 0.70; 95% CI, 0.45-1.10; P = .124). HRs (95% CIs) for 30-day all-cause readmission and all-cause mortality associated with digoxin initiation were 0.95 (0.73-1.23; P = .689) and 0.93 (0.55-1.56; P = .773), respectively. Digoxin initiation had no association with 6-year outcomes.
English
0002-9343
10.1016/j.amjmed.2020.02.040 [doi] S0002-9343(20)30236-9 [pii]
*Cardiotonic Agents/tu [Therapeutic Use]
*Digoxin/tu [Therapeutic Use]
*Heart Failure/dt [Drug Therapy]
*Mortality
*Patient Readmission/sn [Statistics & Numerical Data]
*Stroke Volume
Adrenergic beta-Antagonists/tu [Therapeutic Use]
Aged
Aged, 80 and over
Angiotensin Receptor Antagonists/tu [Therapeutic Use]
Angiotensin-Converting Enzyme Inhibitors/tu [Therapeutic Use]
Anti-Arrhythmia Agents/tu [Therapeutic Use]
Anticoagulants/tu [Therapeutic Use]
Atrial Fibrillation/dt [Drug Therapy]
Atrial Fibrillation/ep [Epidemiology]
Cause of Death
Female
Heart Failure/ep [Epidemiology]
Heart Failure/pp [Physiopathology]
Hospitalization
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/tu [Therapeutic Use]
Male
Mineralocorticoid Receptor Antagonists/tu [Therapeutic Use]
Platelet Aggregation Inhibitors/tu [Therapeutic Use]
Propensity Score
Proportional Hazards Models
Registries
Sodium Potassium Chloride Symporter Inhibitors/tu [Therapeutic Use]
Warfarin/tu [Therapeutic Use]
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Medicine/Internal Medicine
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present
BACKGROUND: Digoxin reduces the risk of heart failure hospitalization in patients with heart failure with reduced ejection fraction. Less is known about this association in patients with heart failure with preserved ejection fraction (HFpEF), the examination of which was the objective of the current study. CONCLUSION: Digoxin initiation prior to hospital discharge was not associated with 30-day or 6-year outcomes in older hospitalized patients with HFpEF. Copyright Published by Elsevier Inc. METHODS: In the Medicare-linked OPTIMIZE-HF registry, 7374 patients hospitalized for HF had ejection fraction >=50% and were not receiving digoxin prior to admission. Of these, 5675 had a heart rate >=50 beats per minute, an estimated glomerular filtration rate >=30 mL/min/1.73 m2 or did not receive inpatient dialysis, and digoxin was initiated in 524 of these patients. Using propensity scores for digoxin initiation, calculated for each of the 5675 patients, we assembled a matched cohort of 513 pairs of patients initiated and not initiated on digoxin, balanced on 58 baseline characteristics (mean age, 80 years; 66% women; 8% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin initiation were estimated in the matched cohort. RESULTS: Among the 1026 matched patients with HFpEF, 30-day heart failure readmission occurred in 6% and 9% of patients initiated and not initiated on digoxin, respectively (HR 0.70; 95% CI, 0.45-1.10; P = .124). HRs (95% CIs) for 30-day all-cause readmission and all-cause mortality associated with digoxin initiation were 0.95 (0.73-1.23; P = .689) and 0.93 (0.55-1.56; P = .773), respectively. Digoxin initiation had no association with 6-year outcomes.
English
0002-9343
10.1016/j.amjmed.2020.02.040 [doi] S0002-9343(20)30236-9 [pii]
*Cardiotonic Agents/tu [Therapeutic Use]
*Digoxin/tu [Therapeutic Use]
*Heart Failure/dt [Drug Therapy]
*Mortality
*Patient Readmission/sn [Statistics & Numerical Data]
*Stroke Volume
Adrenergic beta-Antagonists/tu [Therapeutic Use]
Aged
Aged, 80 and over
Angiotensin Receptor Antagonists/tu [Therapeutic Use]
Angiotensin-Converting Enzyme Inhibitors/tu [Therapeutic Use]
Anti-Arrhythmia Agents/tu [Therapeutic Use]
Anticoagulants/tu [Therapeutic Use]
Atrial Fibrillation/dt [Drug Therapy]
Atrial Fibrillation/ep [Epidemiology]
Cause of Death
Female
Heart Failure/ep [Epidemiology]
Heart Failure/pp [Physiopathology]
Hospitalization
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/tu [Therapeutic Use]
Male
Mineralocorticoid Receptor Antagonists/tu [Therapeutic Use]
Platelet Aggregation Inhibitors/tu [Therapeutic Use]
Propensity Score
Proportional Hazards Models
Registries
Sodium Potassium Chloride Symporter Inhibitors/tu [Therapeutic Use]
Warfarin/tu [Therapeutic Use]
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Medicine/Internal Medicine
Journal Article