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Digoxin use and heart failure outcomes: results from the Valsartan Heart Failure Trial (Val-HeFT)

Javed Butler1, Inder S Anand, Michael A Kuskowski

  • 1Emory University, Atlanta, GA, USA.

Congestive Heart Failure (Greenwich, Conn.)
|October 5, 2010
PubMed

Insights

Digoxin use in heart failure patients was linked to worse outcomes, including higher mortality and hospitalizations. This study suggests reassessing digoxin

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Retrospective studies have questioned digoxin's safety in specific heart failure patient groups.
  • Contemporary heart failure management has evolved, necessitating re-evaluation of older therapies like digoxin.

Purpose of the Study:

  • To evaluate the impact of digoxin therapy on patient outcomes in the current heart failure treatment landscape.
  • To examine the association between baseline digoxin use and mortality, morbidity, and heart failure hospitalizations.

Main Methods:

  • Analysis of 5010 patients from the Valsartan Heart Failure Trial (Val-HeFT).
  • Comparison of outcomes between patients on digoxin versus those not receiving it at baseline.
  • Statistical adjustments for baseline characteristics and propensity-matched analysis.

Main Results:

  • Patients on digoxin had more severe heart failure symptoms and lower ejection fraction.
  • Digoxin use was associated with significantly higher all-cause mortality (21.1% vs 15.0%).
  • Digoxin users experienced more first morbid events (34.6% vs 21.7%) and heart failure hospitalizations (19.1% vs 10.1%).
  • Adjusted analyses confirmed increased risks for mortality (HR 1.28) and events (HR 1.35-1.41) with digoxin use.

Conclusions:

  • Digoxin therapy was not associated with any observed benefit in this contemporary heart failure cohort.
  • Patients receiving digoxin faced a higher risk of adverse outcomes, including mortality and hospitalization.
  • The findings highlight the need to reconsider digoxin's role in current heart failure management strategies.

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