Abstract 20752: Clinical Effectiveness of Digoxin in Hospitalized Older Patients With Heart Failure and Preserved Ejection Fraction: A Propensity-Matched Study of Medicare-Linked OPTIMIZE-HF
Background: In the Digitalis Investigation Group (DIG) Ancillary trial in ambulatory patients with chronic mild to moderate heart failure and preserved ejection fraction (HFpEF) digoxin had no effect on mortality and cardiovascular hospitalization, but reduced the risk of hospitalization due to worsening HF during the first two years of follow-up (PMID: 16864724). We examined the association of digoxin use with outcomes in hospitalized patients with HFpEF.
Methods: In the Medicare-linked OPTIMIZE-HF registry, 8645 hospitalized patients with HF and EF >40% were not receiving digoxin on admission, of which 757 received a new discharge prescription. Propensity scores for digoxin use, estimated for each of the 8645 patients, were used to assemble a cohort of 740 pairs of patients, receiving and not receiving digoxin, who were balanced on 57 baseline characteristics. The 1480 matched patients had a mean (±SD) age of 79 (±10) years, a mean (±SD) EF of 56 (±8) percent, 62% were women, and 7% African American.
Results: During 2.7 years of median follow-up (max, 6 years), all-cause mortality occurred in 68% and 70% of matched patients receiving and not receiving digoxin, respectively (HR, 0.91; 95% CI, 0.80-1.03; Figure). Digoxin use had no association with all-cause readmission (HR, 0.91; 95% CI, 0.82-1.02) or HF readmission (HR, 0.97; 95% CI, 0.83-1.14). Digoxin-associated hazard ratios (95% CIs) for outcomes at 2 years post-discharge were 0.82 (0.70-0.96) for all-cause mortality, 0.93 (0.83-1.05) for all-cause readmission and 0.91 (0.76-1.09) for HF readmission.
Conclusion: Digoxin use was not associated with long-term clinical outcomes among hospitalized HFpEF patients. Importantly, there was no evidence of clinical effectiveness of digoxin on 2-year HF readmission.
Author Disclosures: S. Weerakoon: None. A. Tsimploulis: None. C. Arundel: None. M. Blackman: None. C. Morgan: None. J. Butler: None. G.C. Fonarow: Consultant/Advisory Board; Modest; ZS-9 Consulting. P. Deedwania: None. M. White: None. W.S. Aronow: None. G. Filippatos: None. M. Zile: None. R. Allman: None. A. Ahmed: None.
- © 2016 by American Heart Association, Inc.