Abstract 5910: Digoxin and Outcomes in Patients with Advanced Heart Failure on Contemporary Optimal Treatment
There are no data on effectiveness of digoxin in treatment of advanced heart failure (HF) patients on contemporary optimal medical and device therapy. We studied 455 advanced HF patients (age 52±12years, 68.8% male, 52.5% white, NYHA class 2.5±0.7, LVEF18.3±8%); 227 (49.9%) patients were on digoxin at baseline. The primary endpoint was death (n=101), urgent transplantation (n=14), or left ventricular assist device implantation (n=4); the secondary endpoint was the primary endpoint plus HF hospitalization, while all-cause and HF hospitalizations were recorded. Digoxin use was evaluated with Cox models
in the original cohort;
in a propensity score matched (PSM - on clinical variables, laboratory data, medications, and devices) subset of 322 patients;
as time varying covariate (TVC); and d) after adjustment for the Seattle Heart Failure Score (SHFS).
Patients were on optimal therapy (angiotensin-II modulation 92.5%, beta-blockers 91.2%, aldosterone antagonists 45.6%; defibrillator+/−biventricular pacemaker 71.0%); 39.2% of patients had ischemic etiology of HF and 35% were in atrial fibrillation (AF). Median follow-up time was 27 months. Study outcomes are shown in the table⇓. The rate of primary endpoint was significantly higher in patients receiving digoxin in all the unadjusted, PSM and TVC approach, while the difference on the secondary endpoint and all-cause/HF-related hospitalizations was attenuated by PSM and TVC. Digoxin was associated with higher risk for the primary endpoint among patients in sinus rhythm compared to those in AF (HR 3.19, 95% CI, 1.78–5.72, p<0.001 vs. HR 1.29, 95% CI, 0.69–2.43, p=0.421, p=0.033 for interaction). The results were similar across gender and race, and when adjusted for the SHFS and renal function. In this study, there was no benefit but rather worse outcomes with digoxin therapy. These data question the use of digoxin in advanced HF patients on contemporary optimal therapy.