title: Digoxin use and heart failure outcomes: results from the Valsartan Heart Failure Trial (Val-HeFT).
abstract: Several retrospective studies have raised concerns regarding digoxin therapy in select subgroups of heart failure patients. To assess the impact of digoxin therapy on outcomes in the current era of heart failure therapy, the authors analyzed data representing 5010 patients enrolled in the Valsartan Heart Failure Trial (Val-HeFT) to examine the relationship of baseline digoxin use and all-cause mortality, first morbid event, and heart failure hospitalizations. At baseline, 3374 patients (67%) were receiving digoxin therapy and 1636 (33%) were not. Patients receiving digoxin had features of worse heart failure with higher New York Heart Association class and lower blood pressure, ejection fraction, and β-blocker use (32.1% vs 40.8%). Digoxin use was associated with worse mortality (21.1 vs 15.0%, P<.001), first morbid event (34.6 vs 21.7, P<.001), and HF hospitalization rate (19.1 vs 10.1%, P<.001). After adjustment for baseline group differences including medical therapy and baseline rhythm, patients receiving digoxin remained at a higher risk for all-cause mortality (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.05-1.57), first morbid event (HR, 1.35; 95% CI, 1.15-1.59), and heart failure hospitalization (HR, 1.41; 95% CI, 1.12-1.78). These results remained materially unchanged with propensity matched analysis. No benefit with digoxin use was observed in this study, underscoring the need to reassess the role of digoxin in the contemporary management of heart failure.
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuskowski
authors.forename: Thomas
authors.initials: T
authors.lastname: Rector
authors.forename: Peter
authors.initials: P
authors.lastname: Carson
authors.forename: Jay N
authors.initials: JN
authors.lastname: Cohn
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004077:Digoxin / Q000627:therapeutic use*; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009026:Mortality; D013318:Stroke Volume / Q000187:drug effects; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D013777:Tetrazoles; D004077:Digoxin; D000068756:Valsartan; D014633:Valine