The impact of digoxin on mortality in patients with chronic systolic heart failure: A propensity-matched cohort study

Al-Khateeb, May; Qureshi, Waqas; Odeh, Raed; Ahmed, Amjad; Sakr, Sherif; Elshawi, Radwa; Bdeir, Mohamad; Al-Mallah, Mouaz

doi:10.1016/j.ijcard.2016.11.021

Cited by 17 publications

(17 citation statements)

References 25 publications

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“…9 Similar results were also demonstrated in other studies. [10][11][12] One important question is why efficacy and safety from DIG trial could not be reproduced in recent studies in realworld settings. Several issues are worthy to be discussed.…”

Section: Discussionmentioning

confidence: 99%

“…implantable cardioverter–defibrillators and cardiac resynchronization therapy); thus, cautions are needed to translate previous study results of digoxin into today's clinical practice. In the meantime, recent studies based on either registry database or retrospective analysis showed that digoxin use was associated with increased risk of all‐cause mortality in HFrEF patients . As the use of digoxin varied according to country and ethnicity, in particular in China where the majority of HFrEF patients were treated with digoxin, and some traditional Chinese medicines (TCMs), for example, qili qiangxin capsules, had been shown effective in surrogate endpoints and thus have been recommended by current Chinese guideline for HF, which might interfere with digoxin use .…”

Section: Introductionmentioning

confidence: 99%

“…In the meantime, recent studies based on either registry database or retrospective analysis showed that digoxin use was associated with increased risk of all-cause mortality in HFrEF patients. [9][10][11][12][13] As the use of digoxin varied according to country and ethnicity, [14][15][16][17][18][19] in particular in China where the majority of HFrEF patients were treated with digoxin, and some traditional Chinese medicines (TCMs), for example, qili qiangxin capsules, had been shown effective in surrogate endpoints and thus have been recommended by current Chinese guideline for HF, which might interfere with digoxin use. 1,20,21 Therefore, there are great concern about both efficacy and safety of digoxin in the context of contemporary management of HFrEF in China.…”

Section: Introductionmentioning

confidence: 99%

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Digoxin is associated with worse outcomes in patients with heart failure with reduced ejection fraction

et al. 2020

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Aims The aim of this study was to investigate the impact of digoxin use on the outcomes of patients with heart failure with reduced ejection fraction (HFrEF) and its possible interaction with atrial fibrillation or use of currently guideline‐recommended treatments in the real world in China. Methods and results Patients hospitalized with HFrEF from 45 hospitals participating in the China National Heart Failure Registration Study (CN‐HF) were enrolled to assess the all‐cause mortality, HF mortality, all‐cause re‐hospitalization, and HF re‐hospitalization associated with digoxin use. Eight hundred eighty‐two eligible HFrEF patients in the CN‐HF registry were included: 372 patients with digoxin and 510 patients without digoxin. Among them, 794 (90.0%) patients were followed up for the endpoint events, with a median follow‐up of 28.6 months. Kaplan–Meier survival analysis showed that the all‐cause mortality (P < 0.001) and all‐cause re‐hospitalization (P = 0.020) were significantly higher in digoxin group than non‐digoxin group, while HF mortality (P = 0.232) and HF re‐hospitalization (P = 0.098) were similar between the two groups. The adjusted Cox proportional‐hazards regression analysis demonstrated that digoxin use remained as an independent risk factor for increased all‐cause mortality [hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.27–2.44; P = 0.001] and all‐cause re‐hospitalization (HR 1.27; 95% CI 1.03–1.57; P = 0.029) in HFrEF patients and the predictive value of digoxin for all‐cause mortality irrespective of rhythm or in combination with other guideline‐recommended therapies. Conclusions Digoxin use is independently associated with increased risk of all‐cause mortality and all‐cause re‐hospitalization in HFrEF patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Digoxin is associated with worse outcomes in patients with heart failure with reduced ejection fraction

et al. 2020

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“…It is demonstrated that digoxin was able to improve maximum exercise endurance of patients with mildmoderate stable HF and reduce acute exacerbation of HF whether the basic treatment used diuretics alone or diuretics in combination with ACEIs [11][12][13]. Subsequent studies on digoxin demonstrated that additional use of 0.25 mg/day digoxin on the basis of diuretics and ACEIs could reduce the all-cause and HF exacerbation-induced hospitalization, although it could not reduce the overall mortality of HF patients [14]. A meta-analysis reported that digoxin could reduce the hospitalization rate and relieve clinical symptoms, and it is believed that HF patients could still bene t from the use of digoxin [15].…”

Section: Digoxin and Hfmentioning

confidence: 99%

The effect of autoantibody against M2-muscarinic acetylcholine receptor in peripartum cardiomyopathy patients on digoxin additional to standard treatment

Chen²,

Yin

et al. 2020

Preprint

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Background: To evaluate the effects of autoantibodies against the M2-muscarinic receptor (anti-M2-R) on digoxin additional to standard treatment in peripartum cardiomyopathy (PPCM) patients.Methods: 86 PPCM patients were separated into anti-M2-R negative or positive group according to the anti-M2-R reactivity. All the patients received digoxin additional to standard treatment regimen. Echocardiography was performed at baseline and after 5 years treatment. Serum digoxin concentration (SDC) were performed every 3 to 6 months. All-cause mortality, cardiovascular mortality and re-hospitalization for heart failure were compared after 5 years of follow-up.Results: There were 82 patients completed the final data analysis, including 38 in the anti-M2-R (+) group and 44 in the anti-M2-R (-) group. The heart rate of the positive group was higher than that of the negative group at baseline (102.3 ± 6.3 vs. 95.9 ± 6.8, p < 0.001). The initial SDC of patients in the positive group was higher than that of patients in the negative group with the same dose of digoxin (1.21 ± 0.41 vs. 0.73 ± 0.16 ng/mL, p < 0.001). Patients in the anti-M2-R (-) group had better tolerance to metoprolol and digoxin (p < 0.05). All the PPCM patients showed prominent improvement in cardiac function, especially in the anti-M2-R (-) group. Re-hospitalization for heart failure was decreased in the negative group, but not of all-cause or cardiovascular mortality. Conclusions: Patients negative for anti-M2-R showed better tolerance to metoprolol and digoxin. Anti-M2-R maybe a predictor for vagus nerve overactivation and is associated with poor response to digoxin treatment in PPCM patients.

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“…During these 20 years, several researchers published data that provoked discussion about the safety of treatment with digoxin. The most recent studies questioning the safety of treatment are those by Vamos et al [3], Madelaire et al [4], Qureshi et al [5], Al-Khateeb et al [6], and Katz et al [7]. Other authors showed no influence of digoxin on outcomes of HF patients (e.g.…”

Section: Introductionmentioning

confidence: 99%

Impact of digoxin on risk of death in heart failure patients treated with b-blockers. Results from Polish part of ESC Heart Failure Long-Term Registry

et al. 2018

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The impact of digoxin on mortality in patients with chronic systolic heart failure: A propensity-matched cohort study

Cited by 17 publications

References 25 publications

Digoxin is associated with worse outcomes in patients with heart failure with reduced ejection fraction

Digoxin is associated with worse outcomes in patients with heart failure with reduced ejection fraction

The effect of autoantibody against M2-muscarinic acetylcholine receptor in peripartum cardiomyopathy patients on digoxin additional to standard treatment

Impact of digoxin on risk of death in heart failure patients treated with b-blockers. Results from Polish part of ESC Heart Failure Long-Term Registry

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