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Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: a propensity-matched study of the DIG trial.
Int J Cardiol 2008; 123(2):138-46IJ

Abstract

BACKGROUND

In heart failure (HF), digoxin at low serum digoxin concentrations (SDC) reduces all-cause mortality and HF hospitalizations. However, the effects of digoxin on other cause-specific outcomes have not been studied in a propensity-matched cohort.

METHODS

The Digitalis Investigation Group trial, conducted during 1991-1993, enrolled 7788 ambulatory chronic HF patients. This analysis focuses on 4843 patients: 982 receiving digoxin with low (0.5-0.9 ng/ml) SDC at one month, and 3861 receiving placebo and alive at one month. Propensity scores for low SDC, calculated using a non-parsimonious multivariable logistic regression model, were used to match 982 low-SDC patients with 982 placebo patients. Matched Cox regression analyses were used to determine the effect of digoxin at low SDC on outcomes.

RESULTS

All-cause mortality occurred in 315 placebo (rate, 1071/10,000 person-years) and 288 low-SDC digoxin (rate, 871/10,000 person-years) patients, respectively, during 2940 and 3305 years of follow up (hazard ratio {HR}, 0.81, 95% confidence interval {CI}, 0.68-0.98; p=0.028). Cardiovascular hospitalizations occurred in 493 placebo (2359/10,000 person-year) and 471 low-SDC digoxin (1963/10,000 person-year) patients, respectively during 2090 and 2399 years of follow up (HR, 0.82, 95% CI, 0.70-0.95; P=0.010). Low-SDC digoxin to placebo HR (95%CI) for HF mortality and HF hospitalizations were respectively, 0.65 (0.45-0.92; P=0.015) and 0.63 (0.52-0.77; P<0.0001). Low-dose digoxin (< or = 0.125 mg/day) was the strongest independent predictor of low SDC (adjusted odd ratio, 2.07, 95% CI 1.54-2.80).

CONCLUSIONS

Digoxin at low SDC significantly reduced mortality and hospitalizations in ambulatory chronic systolic and diastolic HF patients.

Authors+Show Affiliations

University of Alabama at Birmingham, 1530 3rd Ave South, CH-19, Ste-219 and VA Medical Center, 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 available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17382417

Citation

Ahmed, Ali, et al. "Effects of Digoxin at Low Serum Concentrations On Mortality and Hospitalization in Heart Failure: a Propensity-matched Study of the DIG Trial." International Journal of Cardiology, vol. 123, no. 2, 2008, pp. 138-46.
Ahmed A, Pitt B, Rahimtoola SH, et al. Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: a propensity-matched study of the DIG trial. Int J Cardiol. 2008;123(2):138-46.
Ahmed, A., Pitt, B., Rahimtoola, S. H., Waagstein, F., White, M., Love, T. E., & Braunwald, E. (2008). Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: a propensity-matched study of the DIG trial. International Journal of Cardiology, 123(2), pp. 138-46.
Ahmed A, et al. Effects of Digoxin at Low Serum Concentrations On Mortality and Hospitalization in Heart Failure: a Propensity-matched Study of the DIG Trial. Int J Cardiol. 2008 Jan 11;123(2):138-46. PubMed PMID: 17382417.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: a propensity-matched study of the DIG trial. AU - Ahmed,Ali, AU - Pitt,Bertram, AU - Rahimtoola,Shahbudin H, AU - Waagstein,Finn, AU - White,Michel, AU - Love,Thomas E, AU - Braunwald,Eugene, Y1 - 2007/03/23/ PY - 2006/11/20/received PY - 2006/12/07/accepted PY - 2007/3/27/pubmed PY - 2008/1/30/medline PY - 2007/3/27/entrez SP - 138 EP - 46 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 123 IS - 2 N2 - BACKGROUND: In heart failure (HF), digoxin at low serum digoxin concentrations (SDC) reduces all-cause mortality and HF hospitalizations. However, the effects of digoxin on other cause-specific outcomes have not been studied in a propensity-matched cohort. METHODS: The Digitalis Investigation Group trial, conducted during 1991-1993, enrolled 7788 ambulatory chronic HF patients. This analysis focuses on 4843 patients: 982 receiving digoxin with low (0.5-0.9 ng/ml) SDC at one month, and 3861 receiving placebo and alive at one month. Propensity scores for low SDC, calculated using a non-parsimonious multivariable logistic regression model, were used to match 982 low-SDC patients with 982 placebo patients. Matched Cox regression analyses were used to determine the effect of digoxin at low SDC on outcomes. RESULTS: All-cause mortality occurred in 315 placebo (rate, 1071/10,000 person-years) and 288 low-SDC digoxin (rate, 871/10,000 person-years) patients, respectively, during 2940 and 3305 years of follow up (hazard ratio {HR}, 0.81, 95% confidence interval {CI}, 0.68-0.98; p=0.028). Cardiovascular hospitalizations occurred in 493 placebo (2359/10,000 person-year) and 471 low-SDC digoxin (1963/10,000 person-year) patients, respectively during 2090 and 2399 years of follow up (HR, 0.82, 95% CI, 0.70-0.95; P=0.010). Low-SDC digoxin to placebo HR (95%CI) for HF mortality and HF hospitalizations were respectively, 0.65 (0.45-0.92; P=0.015) and 0.63 (0.52-0.77; P<0.0001). Low-dose digoxin (< or = 0.125 mg/day) was the strongest independent predictor of low SDC (adjusted odd ratio, 2.07, 95% CI 1.54-2.80). CONCLUSIONS: Digoxin at low SDC significantly reduced mortality and hospitalizations in ambulatory chronic systolic and diastolic HF patients. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/17382417/Effects_of_digoxin_at_low_serum_concentrations_on_mortality_and_hospitalization_in_heart_failure:_a_propensity_matched_study_of_the_DIG_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(07)00287-2 DB - PRIME DP - Unbound Medicine ER -