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The impact of digoxin on mortality in patients with chronic systolic heart failure: A propensity-matched cohort study
May Al-Khateeb1, Waqas T Qureshi2, Raed Odeh1
1King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia; King Abdulaziz Cardiac Centre, Riyadh, Saudi Arabia.
Insights
Digoxin use in heart failure patients on guideline-based therapy was linked to higher all-cause mortality. This study suggests caution with routine digoxin use in well-treated heart failure populations.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Prior studies on digoxin and all-cause mortality (ACM) in heart failure (HF) have yielded mixed results.
- This study investigates digoxin's impact on ACM in a contemporary HF cohort receiving guideline-based therapy.
Purpose of the Study:
- To determine the effect of digoxin use on all-cause mortality in patients with heart failure managed with guideline-directed medical therapy.
Main Methods:
- A cohort of 2298 HF patients from 2000-2015 was analyzed.
- Propensity score matching (2-3:1) was used to compare 325 digoxin users with 750 non-digoxin users.
- The primary outcome assessed was all-cause mortality.
Main Results:
- The matched cohort showed no demographic differences, but digoxin users had worse HF symptoms and more atrial fibrillation.
- Digoxin use was associated with a significant increase in ACM (21.8% vs. 12.9%) after a median follow-up of 4 years.
- This association persisted after adjusting for propensity score, atrial fibrillation, ejection fraction, and NYHA class (HR=1.74).
Conclusions:
- In well-treated HF patients, digoxin use was associated with increased all-cause mortality.
- Further randomized controlled trials are necessary to clarify digoxin's role in contemporary HF management.
- Routine use of digoxin in well-treated HF patients should be reconsidered pending further evidence.
Background:
Prior Studies showed mixed results in association of digoxin use with all-cause mortality (ACM). The aim of this analysis is to identify the impact of digoxin use on ACM in a contemporary heart failure (HF) cohort treated with guideline based therapy.
Methods:
We included 2298 consecutive patients seen in an HF clinic between 2000 and 2015. Patients were considered to be a digoxin user if he/she received digoxin at any point during the enrollment period in the HF clinic. Patients were matched based on digoxin utility using propensity matching in 2-3:1 fashion. The primary outcome was ACM.
Result:
Of 2298 patients, 325 digoxin users were matched with 750 non-digoxin users. The Matched cohort did not have differences among demographics and clinical variables except for worse HF symptomatology and increased prevalence of atrial fibrillation. Overall, the prevalence of the use of guideline suggested therapies was 96%. After a median follow-up duration of 4years (IQR 2-6years), digoxin use was associated with increased ACM (21.8% versus 12.9%, unadjusted HR=1.81; 95% CI=1.33 to 2.45; p=0.001). This association remained significant after adjusting for the propensity score, atrial fibrillation, ejection fraction, and New York HF Class (HR=1.74; 95% CI=1.20 to 2.38; p<0.0001).
Conclusion:
In this analysis of well-treated HF patients, digoxin was associated with increased ACM. Further randomized controlled trials are needed to determine whether digoxin therapy should be used in well-treated HF patients. Until then, routine use of digoxin in clinical practice should be discouraged.
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