Impact of digoxin utilization on clinical outcomes following left ventricular assist device implantation

Abstract

Introduction: We aimed to assess the impact of digoxin use following left ventricular assist device (LVAD) implantation on clinical outcomes. Methods: Patients implanted with continuous flow LVADs at a single academic medical center and survived to initial hospital discharge were included in the analysis ( n = 346). Clinical events were captured at a maximum of 2 years of follow up. Digoxin use was defined as 30-day continuous use post-LVAD. Negative binomial regression and Kaplan-Meier method were used to assess the association between digoxin use and clinical outcomes. Results: Mean age of the cohort was 56 years (±13) and 23% (79/346) were female sex. Digoxin was used in 144 patients (41.6%) for a median of 268 days (IQR 154, 616). Digoxin use was associated with a significant reduction in cumulative incidence of gastrointestinal bleeding (GIB) (15% vs 26%, p = 0.004). After adjusting for age, hypertension, post-operative hemoglobin, RDW, potassium, and GFR, and use of angiotensin receptor/neprilysin inhibitor, there remained a significant 47% reduction in GIB incidence in patients treated with digoxin. There was no significant difference in cumulative incidence in right ventricular failure (RVF) between the two groups. There was no difference in overall 2-year survival between groups. Conclusions: Digoxin use was associated with reduction in GIB events, but not in RVF or mortality. Further studies are needed to confirm these findings and to investigate optimal timing and patient population.

LVAD Continuing Care: A Comprehensive Guide to Long-Term Support and Management

“…With improved cardiac function, higher doses of these medications can be tolerated to further augment reverse remodeling [41]. Digoxin is also frequently added to this regimen for its ionotropic and antiangiogenesis effects [42].…”

Vascular Function in Continuous Flow LVADs: Implications for Clinical Practice

“…The data regarding digoxin’s potential role in LVAD-related GIB management is inconclusive. There are a few retrospective studies linking digoxin use to significant reduction in all-cause GIB, particularly in angiodysplasia-related GIB in CF-LVAD patients [ 71 , 72 , 73 ]. The proposed mechanism is suppression of hypoxia-inducible factor-1 α (HIF-1α), a mediator of angiopoietin-2-induced angiodysplasia [ 71 ].…”

Thrombotic and Hemorrhagic Complications Following Left Ventricular Assisted Device Placement: An Emphasis on Gastrointestinal Bleeding, Stroke, and Pump Thrombosis

“…Digoxin prevents AVM-associated GI bleeding by inhibiting HIF-1a expression [28]. Although continuous digoxin use post-LVAD implantation reduces GI bleeding, its use has not improved the rates of right ventricular failure, mortality, and hospitalization [28,63,64]. The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) 30-day post-LVAD implantation has been shown to decrease the incidence of overall GI bleeding [65,66].…”