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Effects of discontinuation of digoxin versus continuation at low serum digoxin concentrations in chronic heart

Ali Ahmed1, Giovanni Gambassi, Michael T Weaver

  • 1University of Alabama at Birmingham, Birmingham, Alabama, USA. aahmed@uab.edu

The American Journal of Cardiology
|July 17, 2007
PubMed

Insights

Discontinuing digoxin therapy in heart failure patients increases hospitalizations but not mortality. Continuing digoxin at low serum concentrations significantly reduces mortality and hospitalizations for heart failure patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Digoxin discontinuation is linked to worsening heart failure (HF) symptoms.
  • Long-term impacts of digoxin withdrawal on HF mortality and morbidity remain understudied.

Purpose of the Study:

  • To evaluate the long-term effects of digoxin discontinuation versus continuation on mortality and hospitalization in HF patients.
  • To assess the impact of different serum digoxin concentrations (SDC) on clinical outcomes.

Main Methods:

  • Analysis of 7,788 participants from the Digoxin Investigation Group trial.
  • Multivariable Cox regression models were used to analyze data from 3,365 patients with prior digoxin use.
  • Median follow-up was 39.7 months, comparing digoxin continuation (1,666 patients) with discontinuation (1,699 patients).

Main Results:

  • Digoxin discontinuation significantly increased all-cause hospitalization (AHR 1.18) and HF hospitalization (AHR 1.35) compared to continuation.
  • Digoxin discontinuation did not significantly affect all-cause mortality (AHR 1.06).
  • Continuation of digoxin at low SDC (0.5-0.9 ng/ml) significantly reduced all-cause mortality (AHR 0.75), all-cause hospitalization (AHR 0.80), and HF hospitalization (AHR 0.60).

Conclusions:

  • Continuing long-term digoxin therapy at low serum concentrations is associated with reduced mortality and hospitalization in ambulatory chronic HF patients.
  • Digoxin discontinuation increases hospitalization risk in HF patients.
  • Optimizing serum digoxin concentrations may improve outcomes in chronic heart failure management.

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