Effect of digitalis level on readmission and mortality rate among heart failure reduced ejection fraction patients

Alkhawam, Hassan; Abo-Salem, Elsayed; Zaiem, Feras; Ampadu, James; Rahman, Aleef; Sulaiman, Samian; Zaitoun, Anwar; Helmy, Tarek; Vittorio, Timothy J.

doi:10.1016/j.hrtlng.2018.07.006

Cited by 4 publications

(6 citation statements)

References 18 publications

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“…11 Similarly, in a retrospective cohort study of 1047 patients admitted with decompensated HFrEF, digitalis use was associated with increased readmission rates for any reason following discharge. 25 Another interesting finding in our population was a higher necessity of heart transplant during follow-up, which perhaps might be related with a more modest negative remodeling after CRT implantation in patients under DG. In fact, a retrospective study suggests that there was no benefit with DG in a heart transplant referral population of 455 patients with advanced HF receiving medical therapy.…”

Section: Discussionmentioning

confidence: 80%

Digoxin in Patients With Advanced Heart Failure and Sinus Rhythm Submitted to Cardiac Resynchronization Therapy—Is There Any Benefit?

Fernandes

António

Marinho³

et al. 2022

Journal of Cardiovascular Pharmacology

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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 6 3.4 years, we evaluated the effect of DG on the composite end point defined as cardiovascular hospitalization, progression to heart transplantation, and allcause 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 longterm 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 allcause mortality.

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Section: Discussionmentioning

confidence: 80%

Digoxin in Patients With Advanced Heart Failure and Sinus Rhythm Submitted to Cardiac Resynchronization Therapy—Is There Any Benefit?

Fernandes

António

Marinho³

et al. 2022

Journal of Cardiovascular Pharmacology

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“…After reviewing the data on DGX application approaches from the earliest DIG study to the latest REMEDY study, all studies were designed to use the strategy of cDGX during its 2- to 10-year follow-up regardless of whether the congestion status of HF patients was eliminated or not, which tries to continuously improve heart function and obtain a better survival prognosis. The results of these studies found that cDGX was correlated with increased risks of all-cause death [e.g., by (21–72)%] ( 6 , 7 , 14 , 17 , 20 ), CVD [e.g., by (25–32)%] ( 21 ), and HF readmission [e.g., by (21–41)%] ( 22 ) in HF patients. In this real-world, retrospective study, our findings showed that cDGX was indeed related to increased risk of all-cause death (by 84%), CVD (by 1.23-fold), and HF readmission (by 53–61%) compared to iDGX, partially consistent with the recent study by Maciej Tysarowski et al reporting that DGX use was associated with increased mortality in patients with AF and without concomitant HF ( https://doi.org/10.1161/circ.142.suppl_3.16085 ) .…”

Section: Discussionmentioning

confidence: 99%

Association of Digoxin Application Approaches With Long-Term Clinical Outcomes in Rheumatic Heart Disease Patients With Heart Failure: A Retrospective Study

Liu

Lai

Guan

et al. 2021

Front. Cardiovasc. Med.

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Objective: This retrospective, case–control study was executed to assess the effects of digoxin (DGX) use approaches [continuous use of DGX (cDGX) vs. intermittent use of DGX (iDGX)] on the long-term prognosis in rheumatic heart disease (RHD) patients with heart failure (HF).Methods: A total of 642 RHD patients were enrolled to this study after propensity matching. The associations of DGX application approaches with the risks of all-cause mortality, cardiovascular death (CVD), HF re-hospitalization (1-, 3-, and 5-year), and new-onset atrial fibrillation (AF) were analyzed by multivariate Cox proportional hazards or binary logistic regression models, respectively.Results: cDGX was associated with increased risks of all-cause mortality (adjusted HR = 1.84, 95% CI: 1.27–2.65, P = 0.001) and CVD (adjusted HR = 2.23, 95% CI: 1.29–3.83, P = 0.004) in RHD patients with HF compared to iDGX. With exception of 1-year HF re-hospitalization risk, cDGX was associated with increased HF re-hospitalization risk of 3-year (adjusted OR = 1.53, 95% CI: 1.03–2.29, P = 0.037) and 5-year (adjusted OR = 1.61, 95% CI: 1.05–2.50, P = 0.031) as well as new-onset AF (adjusted OR = 2.06, 95% CI: 1.09–3.90, P = 0.027).Conclusion: cDGX was significantly associated with increased risks of all-cause mortality, CVD, medium-/long-term HF re-hospitalization, and new-onset AF in RHD patients with HF.

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“…Comparison of all-cause readmissions at six, 12, and 24 months suggested that digoxin treatment was attributed to an increase in respective rates of readmission at 53%, 34%, and 35%. While conducting analysis based on ethnicity, no benefit to the Caucasian patient population was observed, whereas use of digoxin in the Hispanic and African-American patient populations was associated with worsened or improved outcomes, respectively [22].…”

Section: Reviewmentioning

confidence: 96%

Effects of Digoxin in Heart Failure (HF) With Reduced Ejection Fraction (EF)

Parikh¹,

Patel²,

Pergolizzi³

et al. 2022

Cureus

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In this review, we evaluated the literature on the benefits and deleterious effects of digoxin in heart failure (HF) with reduced ejection fraction (EF). Although digoxin was considered an effective treatment for HF, the supporting evidence is conflicting. Before the conventional use of modern HF therapies, digoxin was widely used for symptomatic relief on these patients. Further randomized trials are required to reach a definite conclusion about its efficacy and safety in patients experiencing HF with a reduced EF (HFrEF).

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Effect of digitalis level on readmission and mortality rate among heart failure reduced ejection fraction patients

Cited by 4 publications

References 18 publications

Digoxin in Patients With Advanced Heart Failure and Sinus Rhythm Submitted to Cardiac Resynchronization Therapy—Is There Any Benefit?

Digoxin in Patients With Advanced Heart Failure and Sinus Rhythm Submitted to Cardiac Resynchronization Therapy—Is There Any Benefit?

Association of Digoxin Application Approaches With Long-Term Clinical Outcomes in Rheumatic Heart Disease Patients With Heart Failure: A Retrospective Study

Effects of Digoxin in Heart Failure (HF) With Reduced Ejection Fraction (EF)

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