Digoxin in Patients With Advanced Heart Failure and Sinus Rhythm Submitted to Cardiac Resynchronization Therapy-Is
Cláudia Fernandes1, Natália António1,2,3,4, Vera Marinho2
1Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Insights
Digoxin use in heart failure patients with reduced ejection fraction undergoing cardiac resynchronization therapy is linked to worse outcomes, including hospitalization and mortality. This finding suggests caution when prescribing digoxin in this population.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Digoxin (DG) use in heart failure with reduced ejection fraction (HFrEF) and sinus rhythm is debated.
- Cardiac resynchronization therapy (CRT) is a treatment for advanced HFrEF.
Purpose of the Study:
- To evaluate the prognostic impact of digoxin in HFrEF patients in sinus rhythm who received CRT.
Main Methods:
- A retrospective study of 297 HFrEF patients in sinus rhythm undergoing CRT.
- Patients were divided into digoxin (DG) and no digoxin (NDG) groups.
- The primary endpoint was a composite of cardiovascular hospitalization, heart transplantation, and all-cause mortality over a mean follow-up of 4.9 years.
Main Results:
- Digoxin use was associated with a higher proportion of the composite endpoint (67% vs. 48%; P=0.002).
- Digoxin remained an independent predictor of adverse outcomes (HR=1.58; P=0.045) after adjusting for confounders.
- CRT response rates were similar between groups.
Conclusions:
- In HFrEF patients with sinus rhythm undergoing CRT, digoxin use is associated with increased cardiovascular hospitalizations, progression to heart transplantation, and all-cause mortality.
- These findings suggest that digoxin may negatively impact prognosis in this specific patient group.
Abstract:
Digoxin (DG) use in patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm remains controversial. We aimed to assess the prognostic effect of DG in patients in sinus rhythm submitted to cardiac resynchronization therapy (CRT). Retrospective study including 297 consecutive patients in sinus rhythm, with advanced HFrEF submitted to CRT. Patients were divided into 2 groups: with DG and without DG (NDG). During a mean follow-up of 4.9 ± 3.4 years, we evaluated the effect of DG on the composite end point defined as cardiovascular hospitalization, progression to heart transplantation, and all-cause mortality. Previous to CRT, 104 patients (35%) chronically underwent DG and 193 patients (65%) underwent NDG treatment. The 2 groups did not differ significantly regarding HF functional class, HF etiology, QRS, and baseline left ventricular ejection fraction. The proportion of responders to CRT was similar in both groups (54% in DG vs. 56% in NDG; P = 0.78). During the long-term follow-up period, the primary end point occurred in a higher proportion in DG patients (67 vs. 48%; P = 0.002). After adjustment for potential confounders, DG use remained as an independent predictor of the composite end point of CV hospitalization, heart transplantation, and all-cause mortality [hazards ratio = 1.58; confidence interval, 95 (1.01-2.46); P = 0.045]. In conclusion, in patients in sinus rhythm with HFrEF submitted to CRT, DG use was associated with CV hospitalization, progression to heart transplant, and all-cause mortality.
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