title: Addition of beta-blockers to digoxin is associated with improved 1- and 10-year survival of patients hospitalized due to decompensated heart failure.
abstract: BACKGROUND
  Many of the studies associating digoxin use with increased mortality were conducted before beta-blockers became a standard therapy for heart failure (HF) patients. Our goal was to determine the effect of beta-blockers on the prognosis of patients hospitalized for decompensated HF who receive digoxin therapy at discharge.
  
  
  METHODS
  We analyzed 2402 patients admitted with a primary diagnosis of decompensated HF during the prospective National Heart Failure Survey in Israel. Multivariate modeling was used to determine the effect of beta-blockers and digoxin on 1- and 10-year survival.
  
  
  RESULTS
  Patients discharged on digoxin and beta-blockers (DIG+/BB+) had a lower 1-year mortality rate than those discharged on digoxin alone (DIG+/BB-), (31% vs. 44%; p<0.001). Digoxin administration was associated with an increase in adjusted 1-year (Hazard ratio [HR] 1.28; 95% confidence interval (CI) 1.08-1.50) and 10-year mortality risk (HR 1.27; CI 1.16-1.42), whereas beta-blocker administration was associated with a decrease in adjusted 1-year (HR 0.76; CI 0.68-0.87) and 10-year mortality risk (HR 0.83; CI 0.77-0.89; all p<0.001). In comparison to a DIG-/BB+ group serving as a reference, multivariate adjusted HR for DIG+/BB+ and DIG+/BB- groups were 1.36 (CI 1.03-1.91; p<0.001) and 2.01 (CI 1.59-2.85; p<0.001) at 1-year, and 1.04 (CI 0.84-1.28; p>0.1) and 1.37 (CI 1.17-1.76; p<0.001) at 10years.
  
  
  CONCLUSIONS
  In patients hospitalized with decompensated HF, digoxin administration at discharge is associated with increased 1- and 10-year mortality risk. However, the simultaneous use of beta-blockers and digoxin is associated with lower 1- and 10-year mortality risk when compared to use of digoxin alone.
authors.affiliation: University of Illinois Hospital and Health Sciences System, Chicago, IL, United States. Electronic address: arikatzmd@gmail.com.
authors.forename: Ari
authors.initials: A
authors.lastname: Katz
authors.affiliation: Neufeld Cardiac Research Institute, Sheba Medical Center, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
authors.affiliation: Neufeld Cardiac Research Institute, Sheba Medical Center, Israel; Leviev Heart Center, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leor
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004077:Digoxin / Q000008:administration & dosage*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D004077:Digoxin
keywords: Beta-blockers; Digoxin; Heart failure; Mortality