title: Clinical predictors of worsening heart failure during withdrawal from digoxin therapy.
abstract: Previous work provides limited information concerning predictors of clinical deterioration after digoxin withdrawal. We investigated the association between selected baseline clinical characteristics and symptomatic deterioration in two similarly designed trials: Prospective Randomized Study of Ventricular Function and Efficacy of Digoxin (PROVED) and Randomized Assessment of Digoxin and Inhibitors of Angiotensin-Converting Enzyme (RADIANCE). Cox proportional-hazards analysis found the following independent predictors of worsening during follow-up in the combined PROVED and RADIANCE patients: heart failure score, left ventricular ejection fraction, cardiothoracic ratio, use of an angiotensin-converting enzyme inhibitor, use of digoxin, and age. When these factors, except for digoxin use, were tested in the subgroup of patients withdrawn from digoxin, they all were significant independent predictors of worsening heart failure. In contrast, only use of angiotensin-converting enzyme inhibitor predicted deterioration in patients who continued digoxin. Patients with more congestive symptoms, worse ventricular function, greater cardiac enlargement, or who were not taking an angiotensin-converting enzyme inhibitor were significantly more likely to worsen early after digoxin discontinuation than patients without these characteristics.
authors.affiliation: Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 27599-7075, USA. kfa@med.unc.edu
authors.forename: K F
authors.initials: KF
authors.lastname: Adams
authors.forename: M
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: B F
authors.initials: BF
authors.lastname: Uretsky
authors.forename: J B
authors.initials: JB
authors.lastname: Young
authors.forename: J H
authors.initials: JH
authors.lastname: Patterson
authors.forename: L
authors.initials: L
authors.lastname: Tomasko
authors.forename: M
authors.initials: M
authors.lastname: Packer
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin