Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure

Robert C. Bourge, Jerome L. Fleg, Gregg C. Fonarow, John G.F. Cleland, John J.V. McMurray, Dirk J. Van Veldhuisen, Mihai Gheorghiade, Kanan Patel, Inmaculada B. Aban, Richard M. Allman, Connie White-Williams, Michel White, Gerasimos S. Filippatos, Stefan D. Anker, Ali Ahmed*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

Background: Heart failure is a leading cause of hospital admission and readmission in older adults. The new United States healthcare reform law has created provisions for financial penalties for hospitals with higher than expected 30-day all-cause readmission rates for hospitalized Medicare beneficiaries aged ≥65 years with heart failure. We examined the effect of digoxin on 30-day all-cause hospital admission in older patients with heart failure and reduced ejection fraction. Methods: In the main Digitalis Investigation Group trial, 6800 ambulatory patients with chronic heart failure (ejection fraction ≤45%) were randomly assigned to digoxin or placebo. Of these, 3405 were aged ≥65 years (mean age, 72 years; 25% were women; 11% were nonwhite). The main outcome in the current analysis was 30-day all-cause hospital admission. Results: In the first 30 days after randomization, all-cause hospitalization occurred in 5.4% (92/1693) and 8.1% (139/1712) of patients in the digoxin and placebo groups, respectively, (hazard ratio {HR} when digoxin was compared with placebo, 0.66; 95% confidence interval {CI}, 0.51-0.86; P =.002). Digoxin also reduced both 30-day cardiovascular (3.5% vs 6.5%; HR, 0.53; 95% CI, 0.38-0.72; P <.001) and heart failure (1.7 vs 4.2%; HR, 0.40; 95% CI, 0.26-0.62; P <.001) hospitalizations, with similar trends for 30-day all-cause mortality (0.7% vs 1.3%; HR, 0.55; 95% CI, 0.27-1.11; P =.096). Younger patients were at lower risk of events but obtained similar benefits from digoxin. Conclusions: Digoxin reduces 30-day all-cause hospital admission in ambulatory older patients with chronic systolic heart failure. Future studies need to examine its effect on 30-day all-cause hospital readmission in hospitalized patients with acute heart failure.

Original languageEnglish (US)
Pages (from-to)701-708
Number of pages8
JournalAmerican Journal of Medicine
Volume126
Issue number8
DOIs
StatePublished - Aug 2013

Keywords

  • 30-day all-cause hospital admission
  • Digoxin
  • Heart failure

ASJC Scopus subject areas

  • Medicine(all)

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