title: Digoxin Use Is Associated With Reduced Interstage Mortality in Patients With No History of Arrhythmia After Stage I Palliation for Single Ventricle Heart Disease.
abstract: BACKGROUND
  Interstage mortality (IM) remains significant after stage 1 palliation (S1P) for single-ventricle heart disease (SVD), with many deaths sudden and unexpected. We sought to determine whether digoxin use post-S1P is associated with reduced IM, utilizing the multicenter database of the National Pediatric Cardiology Quality Improvement Collaborative (NPCQIC).
  
  
  RESULTS
  From June 2008 to July 2013, 816 infants discharged after S1P from 50 surgical sites completed the interstage to stage II palliation, transplant, or IM. Arrhythmia during S1P hospitalization or discharge on antiarrhythmic medications were exclusions (n=270); 2 patients were lost to follow-up. Two analyses were performed: (1) propensity-score adjusted logistic regression with IM as outcome and (2) retrospective cohort analysis for patients discharged on digoxin versus not, matched for surgical site and other established IM risk factors. Of 544 study patients, 119 (21.9%) were discharged on digoxin. Logistic regression analysis with propensity score, site-size group, and digoxin use as predictor variables showed an increased risk of IM in those not discharged on digoxin (odds ratio, 8.6; lower confidence limit, 1.9; upper confidence limit, 38.3; P<0.01). The retrospective cohort analysis for 60 patients on digoxin (matched for site of care, type of S1P, post-S1P ECMO use, genetic syndrome, discharge feeding route, ventricular function, tricuspid regurgitation, and aortic arch gradient) showed 0% IM in the digoxin at discharge group and an estimated IM difference between the 2 groups of 9% (P=0.04).
  
  
  CONCLUSIONS
  Among SVD infants in the NPCQIC database discharged post-S1P with no history of arrhythmia, use of digoxin at discharge was associated with reduced IM.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA (D.W.B.).
authors.forename: David W
authors.initials: DW
authors.lastname: Brown
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.).
authors.forename: Colleen
authors.initials: C
authors.lastname: Mangeot
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.).
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Anderson
authors.affiliation: Independent Consultant, Boston, MA (L.E.P.).
authors.forename: Laura E
authors.initials: LE
authors.lastname: Peterson
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.).
authors.forename: Eileen C
authors.initials: EC
authors.lastname: King
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Lihn
authors.affiliation: University of Texas Health Science Center, San Antonio, TX (S.R.N.).
authors.forename: Steven R
authors.initials: SR
authors.lastname: Neish
authors.affiliation: Arnold Palmer Hospital for Children, Orlando, FL (C.F.).
authors.forename: Craig
authors.initials: C
authors.lastname: Fleishman
authors.affiliation: Nationwide Children's Hospital, Columbus, OH (C.P.).
authors.forename: Christina
authors.initials: C
authors.lastname: Phelps
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.).
authors.forename: Samuel
authors.initials: S
authors.lastname: Hanke
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.).
authors.forename: Robert H
authors.initials: RH
authors.lastname: Beekman
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.).
authors.forename: Carole M
authors.initials: CM
authors.lastname: Lannon
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006352:Heart Ventricles / Q000002:abnormalities / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010166:Palliative Care; D010351:Patient Discharge; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D002317:Cardiovascular Agents; D004077:Digoxin
keywords: cardiovascular disorders; cardiovascular surgery; congenital heart disease; mortality; quality improvement