Abstract 19883: Use of Digoxin and Risk of Death or Readmission for Heart Failure: A Nationwide Propensity-score Matched Study
Background: Digoxin is widely used as symptomatic treatment of patients with chronic heart failure (HF) to prevent readmissions and reduce symptoms in patients with severe HF. However, its role in modern treatment of HF with sinus rhythm is debatable. We investigated risk of death and a hospital readmission in a nationwide cohort of patients with chronic HF and sinus rhythm according to use of digoxin.
Methods: From the Danish National Patient Registry, we identified all patients with HF 1996-2011 alive 30 days after discharge and subsequent use of digoxin after discharge. Patients with atrial fibrillation were excluded. Patients were classified into 4 severity groups according to loop-diuretic dosage. Propensity-score matched Cox regression models were used to analyze risk of death or readmission for HF.
Results: The study population comprised 10,403 HF patients using digoxin and 20,806 propensity-score matched controls without use of digoxin. During 5 year follow-up 21,572 patients died and 27,879 were readmitted for HF. Use of digoxin was associated with an increased risk of death, Hazard Ratio (HR) 1.26 (95% CI 1.23-1.30, P< 0.001) as well as a slightly increased risk of HF readmission, HR 1.06 (1.03-1.08, P< 0.001). In a subgroup analysis digoxin was associated with an increased mortality risk in all severity groups, but was only associated with increased risk of a HF readmission in severity groups 1, 2 and 3, whereas the risk was decreased in severity group 4, HR 0.84 (0.80-0.88, P<0.001) (P=0.036 for interaction).
Conclusion: In chronic HF with sinus rhythm, treatment with digoxin was associated with an increased risk of death and use of digoxin only prevented a readmission for HF in patients requiring high doses of loop diuretics.
Author Disclosures: C. Madelaire: None. M. Schou: None. C. Torp-Pedersen: None. F. Gustafsson: None. L. Køber: None. G.H. Gislason: None.
- © 2014 by American Heart Association, Inc.