TY - BOOK AU - Brar, Vijaywant AU - Gill, Gauravpal S AU - Lam, Phillip H TI - Digoxin Initiation and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction SN - 0002-9343 PY - 2020/// KW - *Cardiotonic Agents/tu [Therapeutic Use] KW - *Digoxin/tu [Therapeutic Use] KW - *Heart Failure/dt [Drug Therapy] KW - *Mortality KW - *Patient Readmission/sn [Statistics & Numerical Data] KW - *Stroke Volume KW - Adrenergic beta-Antagonists/tu [Therapeutic Use] KW - Aged KW - Aged, 80 and over KW - Angiotensin Receptor Antagonists/tu [Therapeutic Use] KW - Angiotensin-Converting Enzyme Inhibitors/tu [Therapeutic Use] KW - Anti-Arrhythmia Agents/tu [Therapeutic Use] KW - Anticoagulants/tu [Therapeutic Use] KW - Atrial Fibrillation/dt [Drug Therapy] KW - Atrial Fibrillation/ep [Epidemiology] KW - Cause of Death KW - Female KW - Heart Failure/ep [Epidemiology] KW - Heart Failure/pp [Physiopathology] KW - Hospitalization KW - Humans KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/tu [Therapeutic Use] KW - Male KW - Mineralocorticoid Receptor Antagonists/tu [Therapeutic Use] KW - Platelet Aggregation Inhibitors/tu [Therapeutic Use] KW - Propensity Score KW - Proportional Hazards Models KW - Registries KW - Sodium Potassium Chloride Symporter Inhibitors/tu [Therapeutic Use] KW - Warfarin/tu [Therapeutic Use] KW - MedStar Heart & Vascular Institute KW - MedStar Washington Hospital Center KW - Medicine/Internal Medicine KW - Journal Article N1 - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present N2 - 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 UR - https://dx.doi.org/10.1016/j.amjmed.2020.02.040 UR - https://dx.doi.org/10.1016/j.amjmed.2020.02.040 ER -