title: Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure.
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.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bourge
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Kanan
authors.initials: K
authors.lastname: Patel
authors.forename: Inmaculada B
authors.initials: IB
authors.lastname: Aban
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.forename: Connie
authors.initials: C
authors.lastname: White-Williams
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use*; D005260:Female; D054143:Heart Failure, Systolic / Q000188:drug therapy* / Q000191:economics; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D058991:Patient Protection and Affordable Care Act; D016896:Treatment Outcome; D014481:United States
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin
keywords: 30-day all-cause hospital admission; Digoxin; Heart failure