Digoxin initiation not associated with outcomes in HFpEF patients

Digoxin initiation prior to hospital discharge does not appear to contribute to 30-day or 6-year outcomes in older hospitalized patients with heart failure with preserved ejection fraction (HFpEF), results of a recent study have shown.

A total of 1,026 matched patients with HFpEF were included in this analysis. Six percent of patients initiated on digoxin and 9 percent not initiated had a 30-day heart failure readmission (hazard ratio [HR], 0.70, 95 percent confidence interval [CI], 0.45–1.10; p=0.124).

Patients who initiated digoxin had an HR of 0.95 (95 percent CI, 0.73–1.23; p=0.689) for 30-day all-cause readmission and 0.93 (95 percent CI, 0.55–1.56; p=0.773) for 30-day all-cause mortality. Of note, digoxin initiation was not associated with 6-year outcomes.

A total of 7,374 patients hospitalized for HF had ejection fraction ≥50 percent and were not receiving digoxin prior to admission in the Medicare-linked OPTIMIZE-HF registry. Of these, 5,675 had a heart rate ≥50 bpm, an estimated glomerular filtration rate ≥30 mL/mim/1.73 m², or did not receive inpatient dialysis. Of these patients, 524 initiated digoxin.

The authors assembled a matched cohort of 513 patients of patients initiated and not initiated on digoxin, balanced on 58 baseline characteristics (mean age, 80 years; 66 percent women; 8 percent African American) using propensity scores for digoxin initiation, calculated for each of the 5,675 patients. Then, they estimated HRs and 95 percent CIs for outcomes associated with digoxin initiation in the matched cohort.