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Association of Digoxin With Interstage Mortality: Results From the Pediatric Heart Network Single Ventricle
Matthew E Oster1, Michael Kelleman2, Courtney McCracken2
1Children's Healthcare of Atlanta, GA (M.E.O., W.T.M.) Emory University School of Medicine, Atlanta, GA (M.E.O., M.K., C.M.C., W.T.M.).
Insights
Infants with single ventricle congenital heart disease had lower interstage mortality when discharged on digoxin. This finding suggests digoxin may be a protective factor during the critical period between surgeries.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Pharmacological Interventions in Infants
Background:
- Infants with single ventricle congenital heart disease face high mortality (8-12%) during the interstage period.
- The interstage period is defined as the time between discharge after the Norwood procedure and before stage II palliation.
Purpose of the Study:
- To investigate the association between digoxin use and interstage mortality in infants with single ventricle congenital heart disease.
Main Methods:
- Retrospective cohort study using the Pediatric Heart Network Single Ventricle Reconstruction Trial dataset (2005-2008).
- Compared interstage mortality between infants discharged on digoxin versus those not on digoxin.
- Utilized parametric survival models, adjusting for center volume, aorta diameter, shunt type, and socioeconomic status.
Main Results:
- 102 of 330 eligible infants (31%) were discharged on digoxin.
- Interstage mortality was 12.3% for infants not on digoxin, compared to 2.9% for those on digoxin.
- Digoxin use was associated with a significantly reduced risk of interstage mortality (adjusted hazard ratio: 3.5; P=0.04).
Conclusions:
- Digoxin use is significantly associated with reduced interstage mortality in infants with single ventricle congenital heart disease.
- No differences in complications were observed between digoxin and non-digoxin groups during the interstage period.
Background:
Mortality for infants with single ventricle congenital heart disease remains as high as 8% to 12% during the interstage period, the time between discharge after the Norwood procedure and before the stage II palliation. The objective of our study was to determine the association between digoxin use and interstage mortality in these infants.
Methods And Results:
We conducted a retrospective cohort study using the Pediatric Heart Network Single Ventricle Reconstruction Trial public use dataset, which includes data on infants with single right ventricle congenital heart disease randomized to receive either a Blalock-Taussig shunt or right ventricle-to-pulmonary artery shunt during the Norwood procedure at 15 institutions in North America from 2005 to 2008. Parametric survival models were used to compare the risk of interstage mortality between those discharged to home on digoxin versus those discharged to home not on digoxin, adjusting for center volume, ascending aorta diameter, shunt type, and socioeconomic status. Of the 330 infants eligible for this study, 102 (31%) were discharged home on digoxin. Interstage mortality for those not on digoxin was 12.3%, compared to 2.9% among those on digoxin, with an adjusted hazard ratio of 3.5 (95% CI, 1.1-11.7; P=0.04). The number needed to treat to prevent 1 death was 11 patients. There were no differences in complications between the 2 groups during the interstage period.
Conclusions:
Digoxin use in infants with single ventricle congenital heart disease is associated with significantly reduced interstage mortality.