title: Temporal Trends of Digoxin Use in Patients Hospitalized With Heart Failure: Analysis From the American Heart Association Get With The Guidelines-Heart Failure Registry.
abstract: The aim of this study was to assess temporal trends and factors associated with digoxin use at discharge among patients admitted with heart failure (HF).
  
  
  
  Digoxin has class IIa recommendations for treating HF with reduced ejection fraction (HFrEF) in the United States. Digoxin use, temporal trends, and clinical characteristics of HF patients in current clinical practice in the United States have not been well studied.
  
  
  
  An observational analysis of 255,901 patients hospitalized with HF (117,761 with HFrEF and 138,140 with preserved EF [HFpEF]) from 398 hospitals participating in the Get With The Guidelines-HF registry between January 2005 and June 2014 was conducted to assess the temporal trends and factors associated with digoxin use.
  
  
  
  Among 117,761 HFrEF patients, only 19.7% received digoxin at discharge. Digoxin prescriptions decreased from 33.1% in 2005 to 10.7% in 2014 (ptrend < 0.0001). Factors associated with digoxin use in HFrEF included atrial fibrillation (AF) (odds ratio [OR]: 2.14; 95% confidence intervals [CI]: 2.02 to 2.28), history of implantable cardioverter defibrillator use (OR: 1.39; 95% CI: 1.32 to 1.46), chronic obstructive pulmonary disease (OR: 1.13, 95% CI: 1.08 to 1.18), diabetes mellitus (OR: 1.10, 95% CI: 1.06 to 1.14), younger age (OR: 0.96, 95% CI: 0.95 to 0.97), lower blood pressure (OR: 0.96, 95% CI: 0.96 to 0.97), and having no history of renal insufficiency (OR: 0.91, 95% CI: 0.85 to 0.97). Use of digoxin in patients with HFpEF (n = 138,140) without AF was 9.8% in 2005, which decreased to 2.2% in 2014 (ptrend < 0.0001).
  
  
  
  One in 5 HFrEF patients received digoxin at discharge, with a significant downward temporal trend in use over the study period. Use of digoxin in HFpEF patients without AF was very low and decreased over the study period.
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida; Division of Cardiology, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma.
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Christine
authors.initials: C
authors.lastname: Ju
authors.affiliation: Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Conrad
authors.initials: C
authors.lastname: Macon
authors.affiliation: Division of Cardiology, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma.
authors.forename: Udho
authors.initials: U
authors.lastname: Thadani
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Division of Cardiology, Brigham and Woman's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Division of Cardiology, Stony Brook School of Medicine, Stony Brook, New York.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California. Electronic address: gfonarow@mednet.ucla.edu.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000367:Age Factors; D000368:Aged; D000572:American Heart Association; D001281:Atrial Fibrillation / Q000453:epidemiology; D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D015897:Comorbidity; D017147:Defibrillators, Implantable; D003920:Diabetes Mellitus / Q000453:epidemiology; D004077:Digoxin / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000639:trends*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology; D013318:Stroke Volume; D014481:United States
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin
keywords: GWTG-HF; digoxin; heart failure; trends