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Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial.
Eur Heart J 2006; 27(2):178-86EH

Abstract

AIMS

To determine the effects of digoxin on all-cause mortality and heart failure (HF) hospitalizations, regardless of ejection fraction, accounting for serum digoxin concentration (SDC).

METHODS AND RESULTS

This comprehensive post-hoc analysis of the randomized controlled Digitalis Investigation Group trial (n=7788) focuses on 5548 patients: 1687 with SDC, drawn randomly at 1 month, and 3861 placebo patients, alive at 1 month. Overall, 33% died and 31% had HF hospitalizations during a 40-month median follow-up. Compared with placebo, SDC 0.5-0.9 ng/mL was associated with lower mortality [29 vs. 33% placebo; adjusted hazard ratio (AHR), 0.77; 95% confidence interval (CI), 0.67-0.89], all-cause hospitalizations (64 vs. 67% placebo; AHR, 0.85; 95% CI, 0.78-0.92) and HF hospitalizations (23 vs. 33% placebo; AHR, 0.62; 95% CI, 0.54-0.72). SDC> or =1.0 ng/mL was associated with lower HF hospitalizations (29 vs. 33% placebo; AHR, 0.68; 95% CI, 0.59-0.79), without any effect on mortality. SDC 0.5-0.9 reduced mortality in a wide spectrum of HF patients and had no interaction with ejection fraction >45% (P=0.834) or sex (P=0.917).

CONCLUSIONS

Digoxin at SDC 0.5-0.9 ng/mL reduces mortality and hospitalizations in all HF patients, including those with preserved systolic function. At higher SDC, digoxin reduces HF hospitalization but has no effect on mortality or all-cause hospitalizations.

Authors+Show Affiliations

University of Alabama at Birmingham, VA Medical Center, 1530 3rd Avenue South, CH-19, Ste-219, Birmingham, AL 35294-2041, USA. aahmed@uab.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16339157

Citation

Ahmed, Ali, et al. "Digoxin and Reduction in Mortality and Hospitalization in Heart Failure: a Comprehensive Post Hoc Analysis of the DIG Trial." European Heart Journal, vol. 27, no. 2, 2006, pp. 178-86.
Ahmed A, Rich MW, Love TE, et al. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J. 2006;27(2):178-86.
Ahmed, A., Rich, M. W., Love, T. E., Lloyd-Jones, D. M., Aban, I. B., Colucci, W. S., ... Gheorghiade, M. (2006). Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. European Heart Journal, 27(2), pp. 178-86.
Ahmed A, et al. Digoxin and Reduction in Mortality and Hospitalization in Heart Failure: a Comprehensive Post Hoc Analysis of the DIG Trial. Eur Heart J. 2006;27(2):178-86. PubMed PMID: 16339157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. AU - Ahmed,Ali, AU - Rich,Michael W, AU - Love,Thomas E, AU - Lloyd-Jones,Donald M, AU - Aban,Inmaculada B, AU - Colucci,Wilson S, AU - Adams,Kirkwood F, AU - Gheorghiade,Mihai, Y1 - 2005/12/08/ PY - 2005/12/13/pubmed PY - 2006/7/21/medline PY - 2005/12/13/entrez SP - 178 EP - 86 JF - European heart journal JO - Eur. Heart J. VL - 27 IS - 2 N2 - AIMS: To determine the effects of digoxin on all-cause mortality and heart failure (HF) hospitalizations, regardless of ejection fraction, accounting for serum digoxin concentration (SDC). METHODS AND RESULTS: This comprehensive post-hoc analysis of the randomized controlled Digitalis Investigation Group trial (n=7788) focuses on 5548 patients: 1687 with SDC, drawn randomly at 1 month, and 3861 placebo patients, alive at 1 month. Overall, 33% died and 31% had HF hospitalizations during a 40-month median follow-up. Compared with placebo, SDC 0.5-0.9 ng/mL was associated with lower mortality [29 vs. 33% placebo; adjusted hazard ratio (AHR), 0.77; 95% confidence interval (CI), 0.67-0.89], all-cause hospitalizations (64 vs. 67% placebo; AHR, 0.85; 95% CI, 0.78-0.92) and HF hospitalizations (23 vs. 33% placebo; AHR, 0.62; 95% CI, 0.54-0.72). SDC> or =1.0 ng/mL was associated with lower HF hospitalizations (29 vs. 33% placebo; AHR, 0.68; 95% CI, 0.59-0.79), without any effect on mortality. SDC 0.5-0.9 reduced mortality in a wide spectrum of HF patients and had no interaction with ejection fraction >45% (P=0.834) or sex (P=0.917). CONCLUSIONS: Digoxin at SDC 0.5-0.9 ng/mL reduces mortality and hospitalizations in all HF patients, including those with preserved systolic function. At higher SDC, digoxin reduces HF hospitalization but has no effect on mortality or all-cause hospitalizations. SN - 0195-668X UR - https://www.unboundmedicine.com/medline/citation/16339157/Digoxin_and_reduction_in_mortality_and_hospitalization_in_heart_failure:_a_comprehensive_post_hoc_analysis_of_the_DIG_trial_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehi687 DB - PRIME DP - Unbound Medicine ER -