Digoxin Initiation and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Digoxin is known to reduce heart failure hospitalizations in patients with reduced ejection fraction.
• Limited data exists regarding digoxin's effect on patients with heart failure with preserved ejection fraction (HFpEF).

Purpose of the Study:

• To investigate the association between digoxin initiation and clinical outcomes in hospitalized patients with HFpEF.

Main Methods:

• The study analyzed data from the OPTIMIZE-HF registry, focusing on 7374 hospitalized patients with HFpEF (ejection fraction ≥50%) not on digoxin.
• A matched cohort of 513 pairs of patients initiated and not initiated on digoxin was created using propensity scores, balancing 58 baseline characteristics.
• Outcomes including 30-day heart failure readmission, 30-day all-cause readmission, and all-cause mortality were assessed.

Main Results:

• Among 1026 matched patients, 30-day heart failure readmission rates were 6% for digoxin initiation versus 9% for no initiation (HR 0.70; P=.124).
• Digoxin initiation showed no significant association with 30-day all-cause readmission (HR 0.95) or all-cause mortality (HR 0.93).
• No association was found between digoxin initiation and 6-year outcomes.

Conclusions:

• Digoxin initiation before hospital discharge was not associated with improved 30-day or 6-year outcomes in older hospitalized HFpEF patients.
• These findings suggest digoxin may not offer significant benefits for this patient population.
• Further investigation is warranted to fully understand digoxin's role in HFpEF management.