Highlights
- •The role of digoxin in older patients with acute heart failure and preserved ejection fraction remains uncertain.
- •In this type of patients, we found that digoxin was associated with higher risk of 1-year adverse events.
- •However, the prognostic effect of digoxin was dependent of heart rate.
- •Digoxin showed to be related with higher risk at lower heart rates.
Abstract
Background
The value of digoxin in heart failure (HF) remains controversial, particularly in
patients with preserved ejection fraction (HFpEF). This study evaluated the 1-year
risk of events after digoxin treatment for acute heart failure (AHF) in patients >70 years
old with HFpEF.
Methods
1833 patients were included in this analysis (mean age, 82 years). The main endpoints
were all-cause death and the composite of death and/or HF re-admission within 1 year.
Cox regression analysis was used to evaluate the association between digoxin treatment
and prognosis.
Results
401 patients received digoxin treatment; of these, 86% had atrial fibrillation. The
mean baseline heart rate was 86 ± 22 bpm. At the 1-year follow-up, 375 patients (20.5%)
died and 684 (37.3%) presented composite endpoints. Patients treated with digoxin
showed higher rates of death (3.21 vs. 2.44 per 10 person-years, p = .019) and composite endpoint (6.72 vs. 5.18 per 10 person-years, p = .003). After multivariate adjustment, digoxin treatment remained associated with
increased risks of death (HR = 1.46, 95% CI: 1.16–1.85, p = .001) and the composite endpoint (HR = 1.35, 95% CI: 1.13–1.61, p = .001). A distinctive
prognostic effect of digoxin was found across the heart rate continuum; the risks
for both endpoints were higher at lower heart rates and neutral at higher heart rates
(p of the interactions = 0.007 and 0.03, respectively).
Conclusions
In older patients with HFpEF discharged after AHF, digoxin treatment was associated
with increased mortality and/or re-admission, particularly in patients with lower
heart rates.
Keywords
Abbreviations:
Acute heart failure (AHF), Angiotensin converting enzyme (ACE), Angiotensin receptor blockers (ARBs), Beat per minute (bpm), Ejection fraction (EF), Fractional polynomials (FP), The estimated glomerular filtration rate, based on the Modification of Diet in Renal Disease (eGFR-MDRD), Hazard ratios (HR), Heart failure (HF), Heart failure preserved ejection fraction (HFpEF), Heart failure reduced ejection fraction (HFrEF), Hemoglobin (Hb), Sinus rhythm (SR), Standard deviation (SD), Systolic blood pressure (SBP)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 22, 2018
Accepted:
October 16,
2018
Received in revised form:
September 6,
2018
Received:
May 14,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
