Helen M Sheriff1, Manik R Thogaripally2, Gurusher Panjrath3, Cherinne Arundel4, Qing Zeng4, Gregg C Fonarow5, Javed Butler6, Ross D Fletcher7, Charity Morgan2, Marc R Blackman8, Prakash Deedwania9, Thomas E Love10, Wilbert S Aronow11, Stefan D Anker12, Richard M Allman13, Ali Ahmed14. 1. Veterans Affairs Medical Center, Washington, DC. 2. University of Alabama at Birmingham, Birmingham, AL. 3. George Washington University, Washington, DC. 4. Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC. 5. Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA. 6. State University of New York, Stony Brook, NY. 7. Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC. 8. Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Georgetown University, Washington, DC. 9. University of California, San Francisco, Fresno, CA. 10. Departments of Medicine, Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, OH. 11. Westchester Medical Center and New York Medical College, Valhalla, NY. 12. Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany & DZHK (German Center for Cardiovascular Research); Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia; Department of Cardiology (CVK); and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Berlin, Germany. 13. Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC. 14. Veterans Affairs Medical Center, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; George Washington University, Washington, DC. Electronic address: aliahmedmdmph@gmail.com.
Abstract
BACKGROUND: Digoxin use has been shown to be associated with a lower risk of 30-day all-cause hospital readmissions in older patients with heart failure (HF). In the current study, we examined this association among long-term care (LTC) residents hospitalized for HF. METHODS: Of the 8049 Medicare beneficiaries discharged alive after hospitalization for HF from 106 Alabama hospitals, 545 (7%) were LTC residents, of which 227 (42%) received discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 545 patients, were used to assemble a matched cohort of 158 pairs of patients receiving and not receiving digoxin who were balanced on 29 baseline characteristics. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin among matched patients were estimated using Cox regression models. RESULTS: Matched patients (n = 316) had a mean age of 83 years, 74% were women, and 18% African American. Thirty-day all-cause readmission occurred in 21% and 20% of patients receiving and not receiving digoxin, respectively (HR, 1.02; 95% CI, 0.63-1.66). Digoxin had no association with all-cause mortality (HR, 0.90; 95% CI, 0.48-1.70), HF readmission (HR, 0.90; 95% CI, 0.38-2.12), or a combined endpoint of all-cause readmission or all-cause mortality (HR, 0.97; 95% CI, 0.65-1.45) at 30 days. These associations remained unchanged at 1 year postdischarge. CONCLUSIONS: The lack of an association between digoxin and 30-day all-cause readmission in older nursing home residents hospitalized for HF is intriguing and needs to be interpreted with caution given the small sample size. Published by Elsevier Inc.
BACKGROUND:Digoxin use has been shown to be associated with a lower risk of 30-day all-cause hospital readmissions in older patients with heart failure (HF). In the current study, we examined this association among long-term care (LTC) residents hospitalized for HF. METHODS: Of the 8049 Medicare beneficiaries discharged alive after hospitalization for HF from 106 Alabama hospitals, 545 (7%) were LTC residents, of which 227 (42%) received discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 545 patients, were used to assemble a matched cohort of 158 pairs of patients receiving and not receiving digoxin who were balanced on 29 baseline characteristics. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin among matched patients were estimated using Cox regression models. RESULTS: Matched patients (n = 316) had a mean age of 83 years, 74% were women, and 18% African American. Thirty-day all-cause readmission occurred in 21% and 20% of patients receiving and not receiving digoxin, respectively (HR, 1.02; 95% CI, 0.63-1.66). Digoxin had no association with all-cause mortality (HR, 0.90; 95% CI, 0.48-1.70), HF readmission (HR, 0.90; 95% CI, 0.38-2.12), or a combined endpoint of all-cause readmission or all-cause mortality (HR, 0.97; 95% CI, 0.65-1.45) at 30 days. These associations remained unchanged at 1 year postdischarge. CONCLUSIONS: The lack of an association between digoxin and 30-day all-cause readmission in older nursing home residents hospitalized for HF is intriguing and needs to be interpreted with caution given the small sample size. Published by Elsevier Inc.
Entities:
Keywords:
Digoxin; heart failure; hospital readmission; nursing home
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