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Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG

Ali Ahmed1, Michael W Rich, Thomas E Love

  • 1University of Alabama at Birmingham, VA Medical Center, 1530 3rd Avenue South, CH-19, Ste-219, Birmingham, AL 35294-2041, USA. aahmed@uab.edu

European Heart Journal
|December 13, 2005
PubMed

Insights

Digoxin at serum concentrations of 0.5-0.9 ng/mL reduces mortality and hospitalizations in heart failure patients. Higher concentrations lower heart failure hospitalizations but do not impact overall mortality.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Digoxin is a widely used medication for heart failure (HF).
  • Its efficacy and safety, particularly concerning mortality and hospitalizations, require precise understanding based on serum digoxin concentration (SDC).
  • Previous studies have not fully elucidated the impact of varying SDCs across the full spectrum of HF patients.

Purpose of the Study:

  • To investigate the effect of different serum digoxin concentrations (SDC) on all-cause mortality and heart failure (HF) hospitalizations.
  • To analyze these effects irrespective of the patient's ejection fraction.
  • To provide evidence-based guidance for digoxin use in HF management.

Main Methods:

  • A post-hoc analysis of the Digitalis Investigation Group (DIG) trial involving 5548 patients.
  • Patients were categorized based on serum digoxin concentration (SDC) measured at 1 month (1687 patients) and compared with 3861 placebo patients.
  • Outcomes including all-cause mortality, all-cause hospitalizations, and HF hospitalizations were assessed over a median follow-up of 40 months.

Main Results:

  • A serum digoxin concentration (SDC) of 0.5-0.9 ng/mL was associated with significantly lower all-cause mortality (29% vs. 33% placebo) and HF hospitalizations (23% vs. 33% placebo).
  • This SDC range also reduced all-cause hospitalizations (64% vs. 67% placebo).
  • Higher SDCs (≥1.0 ng/mL) were linked to reduced HF hospitalizations (29% vs. 33% placebo) but showed no significant effect on mortality or all-cause hospitalizations.

Conclusions:

  • Digoxin therapy targeting a serum concentration of 0.5-0.9 ng/mL demonstrates benefits in reducing mortality and hospitalizations for all heart failure patients, including those with preserved systolic function.
  • Higher serum digoxin concentrations (≥1.0 ng/mL) effectively decrease heart failure hospitalizations but do not influence overall mortality.
  • These findings support optimizing digoxin dosage based on SDC for improved patient outcomes in heart failure management.
Abstract

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