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Digoxin and reduction of heart failure hospitalization in chronic systolic and diastolic heart failure.
Am J Cardiol 2008; 102(12):1681-6AJ

Abstract

In the Digitalis Investigation Group trial, digoxin-associated decrease in the combined end point of heart failure (HF) hospitalization or HF mortality was significant in systolic but not in diastolic HF. To assess whether this apparent disparity could be explained by differences in baseline characteristics and sample size, we used propensity score matching to assemble a cohort of 916 pairs of patients with systolic and diastolic HF who were balanced in all measured baseline covariates. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of the effect of digoxin on outcomes separately in systolic and diastolic HF, at 2 years (protocol prespecified), and at the end of 3.2 years of median follow-up. HF hospitalization or HF mortality occurred in 28% and 32% of patients with systolic HF (HR digoxin vs placebo 0.85, 95% CI 0.67 to 1.08, p = 0.188) and 20% and 25% in those with diastolic HF (HR 0.79, 95% CI 0.60 to 1.03, p = 0.085) receiving digoxin and placebo, respectively. At 2 years, HRs for this combined end point were similar for systolic HF (0.72, 95% CI 0.55 to 0.95, p = 0.022) and diastolic HF (0.69, 95% CI 0.50 to 0.95, p = 0.025). Digoxin also decreased 2-year HF hospitalization in systolic HF (HR 0.73, 95% CI 0.54 to 0.97, p = 0.033) and diastolic HF (HR 0.64, 95% CI 0.45 to 0.90, p = 0.010). In conclusion, as in patients with systolic HF, digoxin was equally effective in those with diastolic HF, who constitute half of all patients with HF, yet have few evidence-based therapeutic options.

Authors+Show Affiliations

Montreal Heart Institute, Montreal, Quebec, Canada.No affiliation info availableNo 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

19064024

Citation

Meyer, Philippe, et al. "Digoxin and Reduction of Heart Failure Hospitalization in Chronic Systolic and Diastolic Heart Failure." The American Journal of Cardiology, vol. 102, no. 12, 2008, pp. 1681-6.
Meyer P, White M, Mujib M, et al. Digoxin and reduction of heart failure hospitalization in chronic systolic and diastolic heart failure. Am J Cardiol. 2008;102(12):1681-6.
Meyer, P., White, M., Mujib, M., Nozza, A., Love, T. E., Aban, I., ... Ahmed, A. (2008). Digoxin and reduction of heart failure hospitalization in chronic systolic and diastolic heart failure. The American Journal of Cardiology, 102(12), pp. 1681-6. doi:10.1016/j.amjcard.2008.05.068.
Meyer P, et al. Digoxin and Reduction of Heart Failure Hospitalization in Chronic Systolic and Diastolic Heart Failure. Am J Cardiol. 2008 Dec 15;102(12):1681-6. PubMed PMID: 19064024.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Digoxin and reduction of heart failure hospitalization in chronic systolic and diastolic heart failure. AU - Meyer,Philippe, AU - White,Michel, AU - Mujib,Marjan, AU - Nozza,Anna, AU - Love,Thomas E, AU - Aban,Inmaculada, AU - Young,James B, AU - Wehrmacher,William H, AU - Ahmed,Ali, Y1 - 2008/10/17/ PY - 2008/04/06/received PY - 2008/05/20/revised PY - 2008/05/20/accepted PY - 2008/12/10/pubmed PY - 2008/12/19/medline PY - 2008/12/10/entrez SP - 1681 EP - 6 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 102 IS - 12 N2 - In the Digitalis Investigation Group trial, digoxin-associated decrease in the combined end point of heart failure (HF) hospitalization or HF mortality was significant in systolic but not in diastolic HF. To assess whether this apparent disparity could be explained by differences in baseline characteristics and sample size, we used propensity score matching to assemble a cohort of 916 pairs of patients with systolic and diastolic HF who were balanced in all measured baseline covariates. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of the effect of digoxin on outcomes separately in systolic and diastolic HF, at 2 years (protocol prespecified), and at the end of 3.2 years of median follow-up. HF hospitalization or HF mortality occurred in 28% and 32% of patients with systolic HF (HR digoxin vs placebo 0.85, 95% CI 0.67 to 1.08, p = 0.188) and 20% and 25% in those with diastolic HF (HR 0.79, 95% CI 0.60 to 1.03, p = 0.085) receiving digoxin and placebo, respectively. At 2 years, HRs for this combined end point were similar for systolic HF (0.72, 95% CI 0.55 to 0.95, p = 0.022) and diastolic HF (0.69, 95% CI 0.50 to 0.95, p = 0.025). Digoxin also decreased 2-year HF hospitalization in systolic HF (HR 0.73, 95% CI 0.54 to 0.97, p = 0.033) and diastolic HF (HR 0.64, 95% CI 0.45 to 0.90, p = 0.010). In conclusion, as in patients with systolic HF, digoxin was equally effective in those with diastolic HF, who constitute half of all patients with HF, yet have few evidence-based therapeutic options. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/19064024/Digoxin_and_reduction_of_heart_failure_hospitalization_in_chronic_systolic_and_diastolic_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(08)01391-X DB - PRIME DP - Unbound Medicine ER -