Abstract 3019: Lack of Benefit and Potential Harm With Digoxin in Hypertensive Heart Failure Patients
Introduction: Digitalis Investigation Group (DIG) trial showed that digoxin did not reduce overall mortality but reduced hospitalization for worsening heart failure (HF). There are limited data on the efficacy and safety of digoxin in hypertensive HF patients, and the benefit of digoxin in patients with hypertension is controversial.
Methods: Out of 7756 patients in DIG database, 1603 patients had history of hypertension and baseline SBP of ≥140 mmHg. Baseline characteristics were compared between digoxin and placebo groups to ensure comparability. Multivariate cox regression analysis was performed to evaluate the effect of digoxin on all cause mortality and admissions due to HF. Subgroup analysis was done, similarly for patients with LVEF ≥40%.
Results: Among the 1603 hypertensive HF patients, the baseline characteristics were comparable in digoxin and placebo groups. Digoxin was associated with a trend towards increased mortality (p=0.08), with no reduction in admissions due to HF (p=0.25) in these patients. Among 625 hypertensive HF patients with LVEF ≥40%, baseline characteristics were similar between digoxin and placebo groups, and digoxin was associated with a significant increase in mortality (p=0.03) with no reduction in admissions due to HF (p=0.25). In contrast, in patients with LVEF<40% (n=978), digoxin was not associated with mortality (p=0.64) or admission due to HF (p=0.60).
Conclusion: This study demonstrates a lack of benefit of digoxin in HF patients with hypertension. Moreover, in hypertensive patients with preserved EF, use of digoxin is associated with increase in mortality and no reduction in HF admissions.