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Digoxin and 30-day all-cause hospital admission in older patients with chronic diastolic heart failure.
Am J Med 2014; 127(2):132-9AJ

Abstract

BACKGROUND

In the main Digitalis Investigation Group (DIG) trial, digoxin reduced the risk of 30-day all-cause hospitalization in older systolic heart failure patients. However, this effect has not been studied in older diastolic heart failure patients.

METHODS

In the ancillary DIG trial, of the 988 patients with chronic heart failure and preserved (> 45%) ejection fraction, 631 were age ≥ 65 years (mean age 73 years, 45% women, 12% non-whites), of whom 311 received digoxin.

RESULTS

All-cause hospitalization 30-day post randomization occurred in 4% of patients in the placebo group and 9% each among those in the digoxin group receiving 0.125 mg and ≥ 0.25 mg a day dosage (P = .026). Hazard ratios (HR) and 95% confidence intervals (CI) for digoxin use overall for 30-day, 3-month, and 12-month all-cause hospitalizations were 2.46 (1.25-4.83), 1.45 (0.96-2.20) and 1.14 (0.89-1.46), respectively. There was one 30-day death in the placebo group. Digoxin-associated HRs (95% CIs) for 30-day hospitalizations due to cardiovascular, heart failure, and unstable angina causes were 2.82 (1.18-6.69), 0.51 (0.09-2.79), and 6.21 (0.75-51.62), respectively. Digoxin had no significant association with 30-day all-cause hospitalization among younger patients (6% vs 7% for placebo; HR 0.80; 95% CI, 0.36-1.79).

CONCLUSIONS

In older patients with chronic diastolic heart failure, digoxin increased the risk of 30-day all-cause hospital admission, but not during longer follow-up. Although chance finding due to small sample size is possible, these data suggest that unlike in systolic heart failure, digoxin may not reduce 30-day all-cause hospitalization in older diastolic heart failure patients.

Authors+Show Affiliations

University of Alabama at Birmingham.University of Alabama at Birmingham.University of Alabama at Birmingham.University of Alabama at Birmingham.University of California, Los Angeles.National Heart, Lung, and Blood Institute, Bethesda, Md.University of Alabama at Birmingham.University of Alabama at Birmingham.University of Alabama at Birmingham; Veterans Affairs Medical Center, Birmingham, Ala.University of Alabama at Birmingham; Veterans Affairs Medical Center, Birmingham, Ala.Medical University of South Carolina, Charleston; The Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC.University of Alabama at Birmingham.University of Alabama at Birmingham; Veterans Affairs Medical Center, Birmingham, Ala. Electronic address: aahmed@uab.edu.

Pub Type(s)

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

Language

eng

PubMed ID

24067296

Citation

Hashim, Taimoor, et al. "Digoxin and 30-day All-cause Hospital Admission in Older Patients With Chronic Diastolic Heart Failure." The American Journal of Medicine, vol. 127, no. 2, 2014, pp. 132-9.
Hashim T, Elbaz S, Patel K, et al. Digoxin and 30-day all-cause hospital admission in older patients with chronic diastolic heart failure. Am J Med. 2014;127(2):132-9.
Hashim, T., Elbaz, S., Patel, K., Morgan, C. J., Fonarow, G. C., Fleg, J. L., ... Ahmed, A. (2014). Digoxin and 30-day all-cause hospital admission in older patients with chronic diastolic heart failure. The American Journal of Medicine, 127(2), pp. 132-9. doi:10.1016/j.amjmed.2013.08.006.
Hashim T, et al. Digoxin and 30-day All-cause Hospital Admission in Older Patients With Chronic Diastolic Heart Failure. Am J Med. 2014;127(2):132-9. PubMed PMID: 24067296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Digoxin and 30-day all-cause hospital admission in older patients with chronic diastolic heart failure. AU - Hashim,Taimoor, AU - Elbaz,Shereen, AU - Patel,Kanan, AU - Morgan,Charity J, AU - Fonarow,Gregg C, AU - Fleg,Jerome L, AU - McGwin,Gerald, AU - Cutter,Gary R, AU - Allman,Richard M, AU - Prabhu,Sumanth D, AU - Zile,Michael R, AU - Bourge,Robert C, AU - Ahmed,Ali, Y1 - 2013/09/23/ PY - 2013/08/22/received PY - 2013/08/22/accepted PY - 2013/9/27/entrez PY - 2013/9/27/pubmed PY - 2014/3/22/medline KW - 30-day all-cause hospital admission KW - Diastolic heart failure KW - Digoxin SP - 132 EP - 9 JF - The American journal of medicine JO - Am. J. Med. VL - 127 IS - 2 N2 - BACKGROUND: In the main Digitalis Investigation Group (DIG) trial, digoxin reduced the risk of 30-day all-cause hospitalization in older systolic heart failure patients. However, this effect has not been studied in older diastolic heart failure patients. METHODS: In the ancillary DIG trial, of the 988 patients with chronic heart failure and preserved (> 45%) ejection fraction, 631 were age ≥ 65 years (mean age 73 years, 45% women, 12% non-whites), of whom 311 received digoxin. RESULTS: All-cause hospitalization 30-day post randomization occurred in 4% of patients in the placebo group and 9% each among those in the digoxin group receiving 0.125 mg and ≥ 0.25 mg a day dosage (P = .026). Hazard ratios (HR) and 95% confidence intervals (CI) for digoxin use overall for 30-day, 3-month, and 12-month all-cause hospitalizations were 2.46 (1.25-4.83), 1.45 (0.96-2.20) and 1.14 (0.89-1.46), respectively. There was one 30-day death in the placebo group. Digoxin-associated HRs (95% CIs) for 30-day hospitalizations due to cardiovascular, heart failure, and unstable angina causes were 2.82 (1.18-6.69), 0.51 (0.09-2.79), and 6.21 (0.75-51.62), respectively. Digoxin had no significant association with 30-day all-cause hospitalization among younger patients (6% vs 7% for placebo; HR 0.80; 95% CI, 0.36-1.79). CONCLUSIONS: In older patients with chronic diastolic heart failure, digoxin increased the risk of 30-day all-cause hospital admission, but not during longer follow-up. Although chance finding due to small sample size is possible, these data suggest that unlike in systolic heart failure, digoxin may not reduce 30-day all-cause hospitalization in older diastolic heart failure patients. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/24067296/Digoxin_and_30_day_all_cause_hospital_admission_in_older_patients_with_chronic_diastolic_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(13)00711-0 DB - PRIME DP - Unbound Medicine ER -