Questionable utility of digoxin in left-ventricular assist device recipients: A multicenter, retrospective analysis

Abstract

BackgroundWhile clinical experience with left ventricular assist devices (LVAD) continues to grow and evolve, little is known regarding the ongoing use of certain medications in this population. We sought to evaluate the utility of digoxin in LVAD recipients and its association with outcomes.MethodsA total of 505 patients who underwent continuous-flow LVAD implantation at 5 centers from 2007–2015 were included. Patients were divided into 4 groups: not on digoxin at any time (ND; n = 257), received digoxin pre implant (PreD; n = 144), received digoxin pre and post implant (ContD; n = 55), and received digoxin only post implant (PostD; n = 49). Survival and all-cause readmission were compared between the 4 groups.ResultsThere was no difference in survival at 1 year nor at 3 years between groups (ND = 88%, 66%, respectively; PreD = 85%, 66%; ContD = 86%, 57%; PostD = 90%, 51%; p = 0.7). Readmission per 100 days also was not different between groups (ND = 0.5, PreD = 0.6, ContD = 0.5, PostD = 0.7; p = 0.1).ConclusionsIn this large, multicenter cohort, use of digoxin was not associated with any significant benefit in regard to mortality or hospitalization in patients supported with a continuous-flow LVAD. Importantly, its discontinuation post implant did not worsen all-cause hospitalization or survival.

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

“…Balachandran et al showed that early digoxin use patients showed improved survival on univariate analysis that went away after multivariate analysis while Pinsino et al showed that digoxin use was associated with lower survival free from hemocompatibility-related adverse events. 22,23 Our results are similar to those published by Ahmed et al 24 in a multicenter, retrospective analysis that showed that digoxin use did not have any impact on post-LVAD survival.…”

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].…”