Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure

Bourge, R. C. et al. (2013) Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure. American Journal of Medicine, 126(8), pp. 701-708. (doi:10.1016/j.amjmed.2013.02.001) (PMID:23490060) (PMCID:PMC3926199)

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Abstract

Background: Heart failure is a leading cause of hospital admission and readmission in older adults. The new United States healthcare reform law has created provisions for financial penalties for hospitals with higher than expected 30-day all-cause readmission rates for hospitalized Medicare beneficiaries aged ≥65 years with heart failure. We examined the effect of digoxin on 30-day all-cause hospital admission in older patients with heart failure and reduced ejection fraction.

Methods: In the main Digitalis Investigation Group trial, 6800 ambulatory patients with chronic heart failure (ejection fraction ≤45%) were randomly assigned to digoxin or placebo. Of these, 3405 were aged ≥65 years (mean age, 72 years; 25% were women; 11% were nonwhite). The main outcome in the current analysis was 30-day all-cause hospital admission.

Results: In the first 30 days after randomization, all-cause hospitalization occurred in 5.4% (92/1693) and 8.1% (139/1712) of patients in the digoxin and placebo groups, respectively, (hazard ratio {HR} when digoxin was compared with placebo, 0.66; 95% confidence interval {CI}, 0.51-0.86; P = .002). Digoxin also reduced both 30-day cardiovascular (3.5% vs 6.5%; HR, 0.53; 95% CI, 0.38-0.72; P < .001) and heart failure (1.7 vs 4.2%; HR, 0.40; 95% CI, 0.26-0.62; P < .001) hospitalizations, with similar trends for 30-day all-cause mortality (0.7% vs 1.3%; HR, 0.55; 95% CI, 0.27-1.11; P = .096). Younger patients were at lower risk of events but obtained similar benefits from digoxin.

Conclusions: Digoxin reduces 30-day all-cause hospital admission in ambulatory older patients with chronic systolic heart failure. Future studies need to examine its effect on 30-day all-cause hospital readmission in hospitalized patients with acute heart failure.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Bourge, R. C., Fleg, J. L., Fonarow, G. C., Cleland, J. G.F., McMurray, J. J.V., van Veldhuisen, D. J., Gheorghiade, M., Patel, K., Aban, I. B., Allman, R. M., White-Williams, C., White, M., Filippatos, G. S., Anker, S. D., and Ahmed, A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:American Journal of Medicine
Publisher:Elsevier
ISSN:0002-9343
ISSN (Online):1555-7162

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