Digoxin Associated With Greater Transplant-Free Survival in High- vs Low-Risk Interstage Patients

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Pharmacology

Background:

• Functional single ventricles with aortic hypoplasia or ductal-dependent systemic circulation often require stage 1 palliation.
• Interstage mortality is a critical concern in these complex pediatric patients.
• The NEONATE score stratifies risk for death or transplantation (DTx) after stage 1 palliation.

Purpose of the Study:

• To investigate the association between digoxin prescription and transplant-free survival in high-risk versus low-risk interstage patients.
• To determine if digoxin provides a variable benefit based on patient risk stratification.
• To identify clinical factors associated with improved outcomes in patients receiving digoxin.

Main Methods:

• A retrospective analysis of patients discharged after stage 1 palliation was conducted using the National Pediatric Cardiology Quality Improvement Collaborative registry.
• Patients were categorized as high- or low-risk using a modified NEONATE score.
• Mixed-effect regression models assessed the association between digoxin and the primary outcome of DTx, adjusting for risk factors.

Main Results:

• Of 1199 patients, 33% were high-risk. High-risk patients had more complex conditions, including Blalock-Taussig shunt, extracorporeal membrane oxygenation, and significant tricuspid regurgitation or arch obstruction.
• Digoxin prescription was associated with a 65% lower odds of DTx in high-risk patients (7.8% vs 19.9%; P=.001).
• No significant difference in DTx rates was observed with digoxin use in the low-risk cohort (4.7% vs 5.7%; P=.46).

Conclusions:

• Digoxin use is linked to improved transplant-free survival specifically in high-risk interstage patients with single ventricle physiology.
• The benefit of digoxin appears stratified by risk, with no significant impact noted in lower-risk populations.
• A personalized approach to digoxin administration in interstage management may be beneficial for optimizing outcomes.