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
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.
Abdelmawgoud, A., Qamer, S., Lam, P., Dooley, D., Prakash, D., Butler, J., Arundel, C., Blackman, M., Morgan, C., Aronow, W. S., Kanonidis, I., Fonarow, G., & Ahmed, A. (2017). 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. Circulation, 136 (Suppl. 1), A18743. Retrieved from https://touroscholar.touro.edu/nymc_fac_abstracts/5