Discontinuation of digoxin in hospitalized older patients with HFrEF was associated with a higher risk of HF readmission at 4 years (HR 1.21; 95% CI 1.05–1.39; p=0.007).
Cohort (n=1,396)
Hazard Ratio: 1.21 (95% CI 1.05–1.39)
p-value: p=0.007
BACKGROUND The deleterious effects of discontinuation of digoxin on outcomes in ambulatory patients with chronic heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting enzyme (ACE) inhibitors are well-documented. OBJECTIVES To determine the relationship between digoxin discontinuation and outcomes in hospitalized patients with HFrEF receiving more contemporary guideline-directed medical therapies (GDMT) including beta-blockers and mineralocorticoid receptor antagonists (MRAs). METHODS Of the 11,900 hospitalized patients with HFrEF (EF ≤45%) in Medicare-linked OPTIMIZE-HF, 3,499 received pre-admission digoxin, which was discontinued in 721 patients. Using propensity scores for digoxin discontinuation, estimated for each of the 3,499 patients, we assembled a matched cohort of 698 pairs of patients, balanced on 50 baseline characteristics (mean age, 76 years; mean EF, 28%; 41% women; 13% African American; 65% on beta-blockers). RESULTS Four-year post-discharge, digoxin discontinuation was associated with significantly higher risks of HF readmission (HR, 1.21; 95% CI, 1.05–1.39; p=0.007), all-cause readmission (HR, 1.16; 95% CI, 1.04–1.31; p=0.010), and the combined endpoint of HF readmission or all-cause mortality (HR, 1.20; 95% CI, 1.07–1.34; p=0.002), but not all-cause mortality (HR, 1.09; 95% CI, 0.97–1.24; p=0.163). Discontinuation of digoxin was associated with a significantly higher risk of all 4 outcomes at 6-month and 1-year post-discharge. At 30 days, digoxin discontinuation was associated with higher risks of all-cause mortality (HR, 1.80; 95% CI, 1.26–2.57; p=0.001) and the combined endpoint (HR, 1.36; 95% CI, 1.07–1.71; p=0.007) but not of HF readmission (HR, 1.19; 95% CI, 0.90–1.59; p=0.226) or all-cause readmission (HR, 1.03; 95% CI, 0.84–1.26; p=0.778). CONCLUSIONS Among hospitalized older patients with HFrEF on more contemporary GDMT, discontinuation of chronic digoxin therapy was associated with poor outcomes.
“What is interesting about this study was that in the face of modern pharmacologic and device therapy for HFrEF, we may have stopped using digoxin prematurely.”
Malik et al. (Mon,) conducted a cohort in Heart Failure with Reduced Ejection Fraction (HFrEF) (n=1,396). Digoxin discontinuation vs. Digoxin continuation was evaluated on HF readmission at 4 years post-discharge (HR 1.21, 95% CI 1.05–1.39, p=0.007). Discontinuation of digoxin in hospitalized older patients with HFrEF was associated with a higher risk of HF readmission at 4 years (HR 1.21; 95% CI 1.05–1.39; p=0.007).