Efficacy and safety of digoxin in patients with heart failure and reduced ejection fraction according to diabetes status: An analysis of the Digitalis Investigation Group (DIG) trial

Abdul-Rahim, A. H. , MacIsaac, R. L., Jhund, P. S. , Petrie, M. C. , Lees, K. R. and McMurray, J. J.V. (2016) Efficacy and safety of digoxin in patients with heart failure and reduced ejection fraction according to diabetes status: An analysis of the Digitalis Investigation Group (DIG) trial. International Journal of Cardiology, 209, pp. 310-316. (doi: 10.1016/j.ijcard.2016.02.074) (PMID:26913372)

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Abstract

Background: Digoxin is recommended in symptomatic heart failure patients with reduced ejection fraction (HF-REF) in sinus rhythm and refractory to other evidence-based therapy. Although HF-REF patients with diabetes have worse functional status than those without, the effects of digoxin have not been specifically evaluated according to diabetes status. Methods: We examined the efficacy and safety of digoxin in HF-REF patients with and without diabetes in the Digitalis Investigation Group trial. Mortality from all-cause, cardiovascular (CV) causes and heart failure (HF), along with HF hospitalisation and suspected digoxin toxicity were analyzed according to diabetes status and randomised treatment assignment. Results: Of the 6800 patients, those with diabetes (n = 1933) were older, more often women, had worse clinical status and more co-morbidity than those without diabetes. All-cause and CV mortality were higher in patients with diabetes than in those without and digoxin did not reduce mortality in either sub-group. The rate of HF hospitalization (per 100 person-years) in patients with diabetes was higher than in those without and was reduced by digoxin in both patient groups: diabetes – placebo 20.5 and digoxin 16.0 (HR 0.79, 95% CI: 0.68–0.91); no diabetes – placebo 12.7 and digoxin 8.7 (HR 0.69, 0.62–0.77); interaction p = 0.14. Suspected digoxin toxicity in patients randomised to digoxin was more common among patients with diabetes than without (6.5% versus 5.8%), as was hospitalisation for digoxin toxicity (1.4% versus 0.8%). Conclusion: Added to an ACE inhibitor, digoxin reduced HF hospitalisation in HF-REF patients with and without diabetes without a substantial risk of toxicity.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Abdul-Rahim, Dr Azmil and Macisaac, Dr Rachael and Lees, Professor Kennedy and Jhund, Dr Pardeep and McMurray, Professor John and Petrie, Professor Mark
Authors: Abdul-Rahim, A. H., MacIsaac, R. L., Jhund, P. S., Petrie, M. C., Lees, K. R., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:International Journal of Cardiology
Journal Abbr.:Int J Cardiol
Publisher:Elsevier
ISSN:0167-5273
Published Online:08 February 2016
Copyright Holders:Copyright © 2016 Elsevier Ireland Ltd.
First Published:First published in International Journal of Cardiology 209:310-316
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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