title: Use of digoxin and risk of death or readmission for heart failure and sinus rhythm: A nationwide propensity score matched study.
abstract: OBJECTIVE
  Digoxin is widely used as symptomatic treatment in heart failure (HF), but the role in contemporary treatment of HF with sinus rhythm (SR) is debatable. We investigated the risk of death and hospital readmission, according to digoxin use, in a nationwide cohort of digoxin-naïve patients with HF and SR.
  
  
  METHODS
  From Danish nationwide registries, digoxin-naïve HF patients from 1996 to 2012 were identified. Patients with cardiac dysrhythmias or use of warfarin were excluded. Digoxin users and non-users were compared in propensity matched cox regression models with respect to primary outcomes of all-cause mortality and HF readmission.
  
  
  RESULTS
  The study population comprised 5327 digoxin users and 10,654 matched non-users with a median age of 77. During follow-up 10,643 (66.6%) patients died and 7584 (47.5%) patients were readmitted due to HF. Use of digoxin was associated with increased risk of death (hazard ratio (HR): 1.19, 95%-CI: 1.15-1.24) and increased risk of HF readmission (HR: 1.19, 95%-CI: 1.13-1.25). Cumulative incidences of readmission, considering death as a competing risk was 50% for digoxin users and 47% for non-users. The associations applied regardless of concomitant HF treatment. In an exploratory analysis considering patients with previous digoxin use, no effect on mortality (HR: 1.00, 95%-CI: 0.94-1.06), nor on HF readmission (HR: 1.00, 95%-CI: 0.93-1.09) was observed.
  
  
  CONCLUSIONS
  In chronic HF with SR, digoxin was associated with a slightly increased risk of death and was not associated with decreased HF readmission rates.
authors.affiliation: Department of Cardiology, The Cardiovascular Research Center, Gentofte University Hospital, DK-2900 Hellerup, Denmark. Electronic address: donmadelaire@gmail.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Madelaire
authors.affiliation: Department of Cardiology, Herlev University Hospital, DK-2730 Herlev, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.affiliation: Department of Cardiology, The Cardiovascular Research Center, Gentofte University Hospital, DK-2900 Hellerup, Denmark.
authors.forename: Karl Emil
authors.initials: KE
authors.lastname: Nelveg-Kristensen
authors.affiliation: Department of Cardiology, The Cardiovascular Research Center, Gentofte University Hospital, DK-2900 Hellerup, Denmark.
authors.forename: Michelle
authors.initials: M
authors.lastname: Schmiegelow
authors.affiliation: Department of Cardiology, DK-8000 Aalborg, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, Rigshospitalet, DK-2100 Copenhagen, Denmark.
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.affiliation: Department of Cardiology, Rigshospitalet, DK-2100 Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Cardiology, The Cardiovascular Research Center, Gentofte University Hospital, DK-2900 Hellerup, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Cardiovascular Epidemiology and Outcomes Research, The Danish Heart Foundation, Copenhagen, Denmark.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Gislason
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004077:Digoxin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D057216:Propensity Score; D012042:Registries; D012307:Risk Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D004077:Digoxin
keywords: Digoxin; Heart failure; Mortality risk; Readmission; Sinus rhythm