The impact of digoxin on mortality in patients with chronic systolic heart failure

A propensity-matched cohort study

May Al-khateeb, Waqas T. Qureshi, Raed Odeh, Amjad M. Ahmed, Sherif Sakr, Radwa Elshawi, M. Bassam Bdeir, Mouaz H. Al-Mallah

Research output: Contribution to journalArticleResearchpeer-review

7 Citations (Scopus)

Abstract

Background Prior Studies showed mixed results in association of digoxin use with all-cause mortality (ACM). The aim of this analysis is to identify the impact of digoxin use on ACM in a contemporary heart failure (HF) cohort treated with guideline based therapy. Methods We included 2298 consecutive patients seen in an HF clinic between 2000 and 2015. Patients were considered to be a digoxin user if he/she received digoxin at any point during the enrollment period in the HF clinic. Patients were matched based on digoxin utility using propensity matching in 2–3:1 fashion. The primary outcome was ACM. Result Of 2298 patients, 325 digoxin users were matched with 750 non-digoxin users. The Matched cohort did not have differences among demographics and clinical variables except for worse HF symptomatology and increased prevalence of atrial fibrillation. Overall, the prevalence of the use of guideline suggested therapies was 96%. After a median follow-up duration of 4 years (IQR 2–6 years), digoxin use was associated with increased ACM (21.8% versus 12.9%, unadjusted HR = 1.81; 95% CI = 1.33 to 2.45; p = 0.001). This association remained significant after adjusting for the propensity score, atrial fibrillation, ejection fraction, and New York HF Class (HR = 1.74; 95% CI = 1.20 to 2.38; p < 0.0001). Conclusion In this analysis of well-treated HF patients, digoxin was associated with increased ACM. Further randomized controlled trials are needed to determine whether digoxin therapy should be used in well-treated HF patients. Until then, routine use of digoxin in clinical practice should be discouraged.

Original languageEnglish
Pages (from-to)214-218
Number of pages5
JournalInternational Journal of Cardiology
Volume228
DOIs
Publication statusPublished - 1 Feb 2017

Fingerprint

Systolic Heart Failure
Digoxin
Cohort Studies
Mortality
Heart Failure
Atrial Fibrillation
Guidelines
Propensity Score
Therapeutics
Randomized Controlled Trials
Demography

Keywords

  • Cardiovascular Disease Management Program
  • Chronic heart failure
  • Digoxin
  • Mortality
  • Propensity matching

Cite this

Al-khateeb, May ; Qureshi, Waqas T. ; Odeh, Raed ; Ahmed, Amjad M. ; Sakr, Sherif ; Elshawi, Radwa ; Bdeir, M. Bassam ; Al-Mallah, Mouaz H. / The impact of digoxin on mortality in patients with chronic systolic heart failure : A propensity-matched cohort study. In: International Journal of Cardiology. 2017 ; Vol. 228. pp. 214-218.
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abstract = "Background Prior Studies showed mixed results in association of digoxin use with all-cause mortality (ACM). The aim of this analysis is to identify the impact of digoxin use on ACM in a contemporary heart failure (HF) cohort treated with guideline based therapy. Methods We included 2298 consecutive patients seen in an HF clinic between 2000 and 2015. Patients were considered to be a digoxin user if he/she received digoxin at any point during the enrollment period in the HF clinic. Patients were matched based on digoxin utility using propensity matching in 2–3:1 fashion. The primary outcome was ACM. Result Of 2298 patients, 325 digoxin users were matched with 750 non-digoxin users. The Matched cohort did not have differences among demographics and clinical variables except for worse HF symptomatology and increased prevalence of atrial fibrillation. Overall, the prevalence of the use of guideline suggested therapies was 96{\%}. After a median follow-up duration of 4 years (IQR 2–6 years), digoxin use was associated with increased ACM (21.8{\%} versus 12.9{\%}, unadjusted HR = 1.81; 95{\%} CI = 1.33 to 2.45; p = 0.001). This association remained significant after adjusting for the propensity score, atrial fibrillation, ejection fraction, and New York HF Class (HR = 1.74; 95{\%} CI = 1.20 to 2.38; p < 0.0001). Conclusion In this analysis of well-treated HF patients, digoxin was associated with increased ACM. Further randomized controlled trials are needed to determine whether digoxin therapy should be used in well-treated HF patients. Until then, routine use of digoxin in clinical practice should be discouraged.",
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The impact of digoxin on mortality in patients with chronic systolic heart failure : A propensity-matched cohort study. / Al-khateeb, May; Qureshi, Waqas T.; Odeh, Raed; Ahmed, Amjad M.; Sakr, Sherif; Elshawi, Radwa; Bdeir, M. Bassam; Al-Mallah, Mouaz H.

In: International Journal of Cardiology, Vol. 228, 01.02.2017, p. 214-218.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - The impact of digoxin on mortality in patients with chronic systolic heart failure

T2 - A propensity-matched cohort study

AU - Al-khateeb, May

AU - Qureshi, Waqas T.

AU - Odeh, Raed

AU - Ahmed, Amjad M.

AU - Sakr, Sherif

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AU - Bdeir, M. Bassam

AU - Al-Mallah, Mouaz H.

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N2 - Background Prior Studies showed mixed results in association of digoxin use with all-cause mortality (ACM). The aim of this analysis is to identify the impact of digoxin use on ACM in a contemporary heart failure (HF) cohort treated with guideline based therapy. Methods We included 2298 consecutive patients seen in an HF clinic between 2000 and 2015. Patients were considered to be a digoxin user if he/she received digoxin at any point during the enrollment period in the HF clinic. Patients were matched based on digoxin utility using propensity matching in 2–3:1 fashion. The primary outcome was ACM. Result Of 2298 patients, 325 digoxin users were matched with 750 non-digoxin users. The Matched cohort did not have differences among demographics and clinical variables except for worse HF symptomatology and increased prevalence of atrial fibrillation. Overall, the prevalence of the use of guideline suggested therapies was 96%. After a median follow-up duration of 4 years (IQR 2–6 years), digoxin use was associated with increased ACM (21.8% versus 12.9%, unadjusted HR = 1.81; 95% CI = 1.33 to 2.45; p = 0.001). This association remained significant after adjusting for the propensity score, atrial fibrillation, ejection fraction, and New York HF Class (HR = 1.74; 95% CI = 1.20 to 2.38; p < 0.0001). Conclusion In this analysis of well-treated HF patients, digoxin was associated with increased ACM. Further randomized controlled trials are needed to determine whether digoxin therapy should be used in well-treated HF patients. Until then, routine use of digoxin in clinical practice should be discouraged.

AB - Background Prior Studies showed mixed results in association of digoxin use with all-cause mortality (ACM). The aim of this analysis is to identify the impact of digoxin use on ACM in a contemporary heart failure (HF) cohort treated with guideline based therapy. Methods We included 2298 consecutive patients seen in an HF clinic between 2000 and 2015. Patients were considered to be a digoxin user if he/she received digoxin at any point during the enrollment period in the HF clinic. Patients were matched based on digoxin utility using propensity matching in 2–3:1 fashion. The primary outcome was ACM. Result Of 2298 patients, 325 digoxin users were matched with 750 non-digoxin users. The Matched cohort did not have differences among demographics and clinical variables except for worse HF symptomatology and increased prevalence of atrial fibrillation. Overall, the prevalence of the use of guideline suggested therapies was 96%. After a median follow-up duration of 4 years (IQR 2–6 years), digoxin use was associated with increased ACM (21.8% versus 12.9%, unadjusted HR = 1.81; 95% CI = 1.33 to 2.45; p = 0.001). This association remained significant after adjusting for the propensity score, atrial fibrillation, ejection fraction, and New York HF Class (HR = 1.74; 95% CI = 1.20 to 2.38; p < 0.0001). Conclusion In this analysis of well-treated HF patients, digoxin was associated with increased ACM. Further randomized controlled trials are needed to determine whether digoxin therapy should be used in well-treated HF patients. Until then, routine use of digoxin in clinical practice should be discouraged.

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KW - Chronic heart failure

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KW - Propensity matching

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