Phillip H Lam1, Milton Packer2, Gauravpal S Gill1, Wen-Chih Wu3, Wayne C Levy4, Michael R Zile5, Vijaywant Brar6, Cherinne Arundel7, Yan Cheng8, Steven N Singh9, Richard M Allman10, Gregg C Fonarow11, Ali Ahmed12. 1. Veterans Affairs Medical Center, Washington, DC; MedStar Washington Hospital Center, Washington, DC; Georgetown University, Washington, DC. 2. Baylor University Medical Center, Dallas, TX. 3. Brown University, Providence, RI; Veterans Affairs Medical Center, Providence, RI. 4. University of Washington, Seattle, WA. 5. Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC. 6. MedStar Washington Hospital Center, Washington, DC; Georgetown University, Washington, DC. 7. Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC. 8. Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC. 9. Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC. 10. George Washington University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL. 11. University of California, Los Angeles, CA. 12. Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC. Electronic address: ali.ahmed@va.gov.
Abstract
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. 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. CONCLUSION: Digoxin initiation prior to hospital discharge was not associated with 30-day or 6-year outcomes in older hospitalized patients with HFpEF. Published by Elsevier Inc.
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. 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. CONCLUSION: Digoxin initiation prior to hospital discharge was not associated with 30-day or 6-year outcomes in older hospitalized patients with HFpEF. Published by Elsevier Inc.
Entities:
Keywords:
Digoxin; Heart failure with preserved ejection fraction; Mortality; Readmission
Authors: Jakub Benko; Matej Samoš; Tomáš Bolek; Dana Prídavková; Jakub Jurica; Martin Jozef Péč; Peter Galajda; Marián Mokáň Journal: J Diabetes Res Date: 2022-03-07 Impact factor: 4.011