Digoxin and Hospital Readmission in Older Patients With Heart Failure and Reduced Ejection Fraction Receiving Beta Blockers: a Propensity Matched Study of Medicare Linked Optimize HF

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Publication Date

November 2017

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Background: In patients with heart failure (HF), digoxin reduces the risk of 30day allcause readmission (PMCID: PMC3929967). In the current study, we examined if digoxin use is associated with lower 30day allcause readmission in hospitalized patients with HF and reduced EF (HFrEF) receiving betablockers (BBs). Methods: In the Medicarelinked OPTIMIZEHF registry, of the 10625 hospitalized patients with HFrEF (EF ≤40%), 7601 received a discharge prescription for BBs. We restricted our analysis to an inception cohort of 5307 patients who were not receiving digoxin on admission. Of these, 1075 received a new discharge prescription for digoxin. Propensity scores for digoxin use, estimated for each of the 5307 patients, were used to assemble a cohort of 1043 pairs of patients, receiving and not receiving digoxin, balanced on 46 baseline characteristics. All results are based on 2086 matched patients who had a mean (±SD) age of 75 (±11) years and EF of 25 (±8) percent, 42% were women, and 13% African American. Results: Digoxin use was associated with a lower risk of HF readmission (HR, 0.85; 95% CI, 0.730.98), allcause readmission (HR, 0.90; 95% CI, 0.800.997), combined endpoint of allcause readmission or mortality (HR, 0.90; 95% CI, 0.820.998) at 1 year, but not allcause mortality (HR, 1.03; 95% CI, 0.871.21). HRs (95% CIs) for allcause and HF readmission and allcause mortality at 30 days were 0.88 (0.731.06), 0.74 (0.550.996), and 0.79 (0.541.14), respectively. Conclusion: In older patients with HFrEF receiving BBs, discharge initiation of digoxin appear to be associated with a lower risk of allcause and HF readmission, but not of mortality.