Digoxin lowers risk of readmission in older patients with heart failure, atrial fibrillation

Initiation of digoxin appears to reduce the risk of readmission among hospitalized older patients with heart failure (HF) and atrial fibrillation (AF), a study has shown. Furthermore, digoxin initiation shows no association with mortality.

The authors carried out an observational propensity score-matched study of predischarge digoxin initiation in 1,768 hospitalized patients with HF and AF (mean age, 79 years; 55 percent women; 7 percent African American) in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, balanced on 56 baseline characteristics.

They also estimated hazard ratios (HRs) and 95 percent confidence intervals (CIs) for outcomes in 884 patients initiated on digoxin and 884 not on digoxin.

HRs for all-cause mortality were 0.80 (95 percent CI, 0.55–1.18; p=0.261) at 30 days, 0.94 (95 percent CI, 0.87–1.16; p=0.936) at 2 years, and 1.01 (95 percent CI, 0.90–1.14; p=0.729) at 4 years.

The respective HRs for HF readmission were 0.67 (95 percent CI, 0.49–0.92; p=0.014), 0.81 (95 percent CI, 0.69–0.94; p=0.005), and 0.85 (95 percent CI, 0.74–0.97; p=0.022), while those for all-cause readmission were 0.78 (95 percent CI, 0.64–0.96; p=0.016), 0.90 (95 percent CI, 0.81–1.00; p=0.057), and 0.91 (95 percent CI, 0.83–1.01; p=0.603).

Such association with digoxin initiation were homogeneous between patients with left ventricular ejection fraction ≤45 percent versus >45 percent.

“Digoxin reduces the risk of HF hospitalization but has no effect on mortality in patients with HF without AF in the randomized controlled trial setting,” the authors said. “Observational studies of digoxin use in patients with AF have suggested a higher risk for poor outcomes.”