title: Digoxin therapy and the risk of primary cardiac arrest in patients with congestive heart failure: effect of mild-moderate renal impairment.
abstract: OBJECTIVE
  The cardiac safety of digoxin therapy for congestive heart failure (CHF) is a source of concern, especially among those with renal impairment.
  
  
  METHODS
  Using a case-control design, we examined the risk of primary cardiac arrest (PCA) associated with digoxin therapy within three levels of renal function.
  
  
  RESULTS
  After adjustment for other clinical characteristics, digoxin therapy for CHF was not associated with an increased risk of PCA [odds ratio (OR)=0.97, 95% confidence interval (CI) 0.59-1.62] among patients with normal renal function (serum creatinine </=1.1 mg/dL). In contrast, digoxin therapy was associated with a modest increase in risk (OR=1.58, CI 0.89-2.80) among patients with mild renal impairment (serum creatinine=1.2-1.4 mg/dL); and a twofold increase in risk (OR=2.39, CI 1.37-4.18) among patients with moderate renal impairment (serum creatinine=1.5-3.5 mg/dL).
  
  
  CONCLUSIONS
  These findings suggest that the risks of digoxin may offset the benefits among patients with moderately impaired renal function, but not among patients with normal renal function.
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Department of Medicine, Metropolitan Park, 1730 Minor Avenue, East Tower, Seattle, WA 98101, USA. rea123@u.washington.edu
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Pearce
authors.forename: Trivellore E
authors.initials: TE
authors.lastname: Raghunathan
authors.forename: Eric A
authors.initials: EA
authors.lastname: Whitsel
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Cobb
authors.forename: Sheila
authors.initials: S
authors.lastname: Weinmann
authors.forename: Gail D
authors.initials: GD
authors.lastname: Anderson
authors.forename: Patrick
authors.initials: P
authors.lastname: Arbogast
authors.forename: Danyu
authors.initials: D
authors.lastname: Lin
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D004077:Digoxin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000503:physiopathology; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin; D003404:Creatinine