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Serum digoxin concentration and outcomes in women with heart failure: A bi-directional effect and a possible effect

Ali Ahmed1, Inmaculada B Aban, Michael T Weaver

  • 1Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. aahmed@uab.edu

European Journal of Heart Failure
|November 29, 2005
PubMed

Insights

Digoxin’s effect on heart failure outcomes in women is bidirectional and depends on serum digoxin concentration (SDC). Beneficial effects were significant only in women with reduced ejection fraction (EF<35%).

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • The relationship between serum digoxin concentration (SDC) and heart failure (HF) outcomes in women remains understudied.
  • Previous research suggests a bidirectional effect of digoxin in men, influenced by SDC.

Purpose of the Study:

  • To investigate if digoxin's impact on HF outcomes in women is bidirectional and SDC-dependent, similar to men.
  • To determine if ejection fraction (EF) modifies the effect of digoxin in women with HF.

Main Methods:

  • Analysis of 1366 female participants from the Digitalis Investigation Group trial with available SDC data.
  • Calculation of adjusted odds ratios (AOR) and 97.5% confidence intervals (CI) for mortality and HF hospitalization.
  • Stratification of analyses by EF (<35% and ≥35%) with a median follow-up of 41 months.

Main Results:

  • Higher SDC (≥1.2 ng/ml) was associated with increased mortality (AOR=1.80) compared to placebo.
  • Lower SDC (0.5-1.1 ng/ml) was associated with reduced HF hospitalization rates (AOR=0.63) in women with EF<35%.
  • In women with EF≥35%, SDC 0.5-1.1 ng/ml showed a borderline association with increased mortality (AOR=1.58) and no significant effect on HF hospitalization.

Conclusions:

  • Digoxin exhibits a bidirectional effect on HF outcomes in women, contingent on SDC.
  • The beneficial effects of digoxin for HF hospitalization were observed exclusively in women with reduced ejection fraction (EF<35%).
  • The findings support SDC monitoring and consideration of EF when prescribing digoxin for heart failure in women.
Abstract

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