Ari Katz1, Elad Maor2, Jonathan Leor3, Robert Klempfner4. 1. University of Illinois Hospital and Health Sciences System, Chicago, IL, United States. Electronic address: arikatzmd@gmail.com. 2. Neufeld Cardiac Research Institute, Sheba Medical Center, Israel. 3. Neufeld Cardiac Research Institute, Sheba Medical Center, Israel; Leviev Heart Center, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel. 4. Leviev Heart Center, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
Abstract
BACKGROUND: Many of the studies associating digoxin use with increased mortality were conducted before beta-blockers became a standard therapy for heart failure (HF) patients. Our goal was to determine the effect of beta-blockers on the prognosis of patients hospitalized for decompensated HF who receive digoxin therapy at discharge. METHODS: We analyzed 2402 patients admitted with a primary diagnosis of decompensated HF during the prospective National Heart Failure Survey in Israel. Multivariate modeling was used to determine the effect of beta-blockers and digoxin on 1- and 10-year survival. RESULTS: Patients discharged on digoxin and beta-blockers (DIG+/BB+) had a lower 1-year mortality rate than those discharged on digoxin alone (DIG+/BB-), (31% vs. 44%; p<0.001). Digoxin administration was associated with an increase in adjusted 1-year (Hazard ratio [HR] 1.28; 95% confidence interval (CI) 1.08-1.50) and 10-year mortality risk (HR 1.27; CI 1.16-1.42), whereas beta-blocker administration was associated with a decrease in adjusted 1-year (HR 0.76; CI 0.68-0.87) and 10-year mortality risk (HR 0.83; CI 0.77-0.89; all p<0.001). In comparison to a DIG-/BB+ group serving as a reference, multivariate adjusted HR for DIG+/BB+ and DIG+/BB- groups were 1.36 (CI 1.03-1.91; p<0.001) and 2.01 (CI 1.59-2.85; p<0.001) at 1-year, and 1.04 (CI 0.84-1.28; p>0.1) and 1.37 (CI 1.17-1.76; p<0.001) at 10years. CONCLUSION: In patients hospitalized with decompensated HF, digoxin administration at discharge is associated with increased 1- and 10-year mortality risk. However, the simultaneous use of beta-blockers and digoxin is associated with lower 1- and 10-year mortality risk when compared to use of digoxin alone.
BACKGROUND: Many of the studies associating digoxin use with increased mortality were conducted before beta-blockers became a standard therapy for heart failure (HF) patients. Our goal was to determine the effect of beta-blockers on the prognosis of patients hospitalized for decompensated HF who receive digoxin therapy at discharge. METHODS: We analyzed 2402 patients admitted with a primary diagnosis of decompensated HF during the prospective National Heart Failure Survey in Israel. Multivariate modeling was used to determine the effect of beta-blockers and digoxin on 1- and 10-year survival. RESULTS:Patients discharged on digoxin and beta-blockers (DIG+/BB+) had a lower 1-year mortality rate than those discharged on digoxin alone (DIG+/BB-), (31% vs. 44%; p<0.001). Digoxin administration was associated with an increase in adjusted 1-year (Hazard ratio [HR] 1.28; 95% confidence interval (CI) 1.08-1.50) and 10-year mortality risk (HR 1.27; CI 1.16-1.42), whereas beta-blocker administration was associated with a decrease in adjusted 1-year (HR 0.76; CI 0.68-0.87) and 10-year mortality risk (HR 0.83; CI 0.77-0.89; all p<0.001). In comparison to a DIG-/BB+ group serving as a reference, multivariate adjusted HR for DIG+/BB+ and DIG+/BB- groups were 1.36 (CI 1.03-1.91; p<0.001) and 2.01 (CI 1.59-2.85; p<0.001) at 1-year, and 1.04 (CI 0.84-1.28; p>0.1) and 1.37 (CI 1.17-1.76; p<0.001) at 10years. CONCLUSION: In patients hospitalized with decompensated HF, digoxin administration at discharge is associated with increased 1- and 10-year mortality risk. However, the simultaneous use of beta-blockers and digoxin is associated with lower 1- and 10-year mortality risk when compared to use of digoxin alone.
Authors: Christopher J Rush; Ross T Campbell; Pardeep S Jhund; Mark C Petrie; John J V McMurray Journal: Eur Heart J Date: 2018-10-01 Impact factor: 29.983