Digoxin and 30-day all-cause hospital admission in older patients with chronic diastolic heart failure.
BACKGROUND
In the main Digitalis Investigation Group (DIG) trial, digoxin reduced the risk of 30-day all-cause hospitalization in older systolic heart failure patients. However, this effect has not been studied in older diastolic heart failure patients.


METHODS
In the ancillary DIG trial, of the 988 patients with chronic heart failure and preserved (> 45%) ejection fraction, 631 were age ≥ 65 years (mean age 73 years, 45% women, 12% non-whites), of whom 311 received digoxin.


RESULTS
All-cause hospitalization 30-day post randomization occurred in 4% of patients in the placebo group and 9% each among those in the digoxin group receiving 0.125 mg and ≥ 0.25 mg a day dosage (P = .026). Hazard ratios (HR) and 95% confidence intervals (CI) for digoxin use overall for 30-day, 3-month, and 12-month all-cause hospitalizations were 2.46 (1.25-4.83), 1.45 (0.96-2.20) and 1.14 (0.89-1.46), respectively. There was one 30-day death in the placebo group. Digoxin-associated HRs (95% CIs) for 30-day hospitalizations due to cardiovascular, heart failure, and unstable angina causes were 2.82 (1.18-6.69), 0.51 (0.09-2.79), and 6.21 (0.75-51.62), respectively. Digoxin had no significant association with 30-day all-cause hospitalization among younger patients (6% vs 7% for placebo; HR 0.80; 95% CI, 0.36-1.79).


CONCLUSIONS
In older patients with chronic diastolic heart failure, digoxin increased the risk of 30-day all-cause hospital admission, but not during longer follow-up. Although chance finding due to small sample size is possible, these data suggest that unlike in systolic heart failure, digoxin may not reduce 30-day all-cause hospitalization in older diastolic heart failure patients.
University of Alabama at Birmingham.
Taimoor
T
Hashim
University of Alabama at Birmingham.
Shereen
S
Elbaz
University of Alabama at Birmingham.
Kanan
K
Patel
University of Alabama at Birmingham.
Charity J
CJ
Morgan
University of California, Los Angeles.
Gregg C
GC
Fonarow
National Heart, Lung, and Blood Institute, Bethesda, Md.
Jerome L
JL
Fleg
University of Alabama at Birmingham.
Gerald
G
McGwin
University of Alabama at Birmingham.
Gary R
GR
Cutter
University of Alabama at Birmingham; Veterans Affairs Medical Center, Birmingham, Ala.
Richard M
RM
Allman
University of Alabama at Birmingham; Veterans Affairs Medical Center, Birmingham, Ala.
Sumanth D
SD
Prabhu
Medical University of South Carolina, Charleston; The Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC.
Michael R
MR
Zile
University of Alabama at Birmingham.
Robert C
RC
Bourge
University of Alabama at Birmingham; Veterans Affairs Medical Center, Birmingham, Ala. Electronic address: aahmed@uab.edu.
Ali
A
Ahmed
D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004077:Digoxin / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D054144:Heart Failure, Diastolic / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D018401:Sample Size; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D004077:Digoxin
30-day all-cause hospital admission; Diastolic heart failure; Digoxin