Digoxin and 30-Day All-Cause Hospital Admission in Older Patients With Chronic Diastolic Heart Failure
What is the impact of digoxin therapy on elderly diastolic heart failure (HF) patients?
The study cohort was comprised of patients from the ancillary DIG (Digitalis Investigation Group) trial and included 988 chronic HF patients with preserved left ventricular ejection fraction (>45%), of whom 631 were ages ≥65 years (mean age 73 years, 45% women, 12% nonwhites); 311 patients from this group received digoxin.
The investigators reported that all-cause hospitalization 30 days post-randomization occurred in 4% of patients in the placebo group and 9% each among those in the digoxin group receiving 0.125 mg and ≥0.25 mg a day dosage (p = 0.026). Overall, hazard ratios (HRs) and 95% confidence intervals (CIs) for digoxin use for 30-day, 3-month, and 12-month all-cause hospitalizations were 2.46 (1.25-4.83), 1.45 (0.96-2.20), and 1.14 (0.89-1.46), respectively. In the placebo group, there was one 30-day mortality. HRs (95% CIs) with digoxin for 30-day hospitalizations due to cardiovascular, HF, and unstable angina causes were 2.82 (1.18-6.69), 0.51 (0.09-2.79), and 6.21 (0.75-51.62), respectively. Digoxin had no significant association with 30-day all-cause hospitalization among younger patients (6% vs. 7% for placebo; HR, 0.80; 95% CI, 0.36-1.79).
The authors concluded that: i) digoxin increased the risk of 30-day all-cause hospital admission in older patients with diastolic HF, but not during longer follow-up, ii) and digoxin may not reduce 30-day all-cause hospitalization in older diastolic HF patients (although chance finding due to small sample size is possible).
This study suggests that digoxin increases the risk of admission in older patients with diastolic HF unlike in systolic HF patients, where there it reduced the risk of 30-day all-cause hospital admission and was associated with lower 30-day all-cause hospital readmission. Another important observation of this study is that it only included patients with sinus rhythm; and therefore, these findings cannot be applied to those with atrial fibrillation. Given digoxin had no mortality benefit in the DIG trials, the utilization of digoxin in diastolic HF is best limited to those in atrial fibrillation where other options have been exhausted.
Keywords: Heart Failure, Diastolic, Patient Readmission, Digoxin, Digitalis Glycosides, Stroke Volume, Hospitalization
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