Digoxin and 30-day All-cause Hospital Admission in Older Patients with Chronic Diastolic Heart Failure - 23/01/14
Abstract |
Background |
In the main Digitalis Investigation Group (DIG) trial, digoxin reduced the risk of 30-day all-cause hospitalization in older systolic heart failure patients. However, this effect has not been studied in older diastolic heart failure patients.
Methods |
In the ancillary DIG trial, of the 988 patients with chronic heart failure and preserved (> 45%) ejection fraction, 631 were age ≥ 65 years (mean age 73 years, 45% women, 12% non-whites), of whom 311 received digoxin.
Results |
All-cause hospitalization 30-day post randomization occurred in 4% of patients in the placebo group and 9% each among those in the digoxin group receiving 0.125 mg and ≥ 0.25 mg a day dosage (P = .026). Hazard ratios (HR) and 95% confidence intervals (CI) for digoxin use overall for 30-day, 3-month, and 12-month all-cause hospitalizations were 2.46 (1.25-4.83), 1.45 (0.96-2.20) and 1.14 (0.89-1.46), respectively. There was one 30-day death in the placebo group. Digoxin-associated HRs (95% CIs) for 30-day hospitalizations due to cardiovascular, heart failure, and unstable angina causes were 2.82 (1.18-6.69), 0.51 (0.09-2.79), and 6.21 (0.75-51.62), respectively. Digoxin had no significant association with 30-day all-cause hospitalization among younger patients (6% vs 7% for placebo; HR 0.80; 95% CI, 0.36-1.79).
Conclusions |
In older patients with chronic diastolic heart failure, digoxin increased the risk of 30-day all-cause hospital admission, but not during longer follow-up. Although chance finding due to small sample size is possible, these data suggest that unlike in systolic heart failure, digoxin may not reduce 30-day all-cause hospitalization in older diastolic heart failure patients.
El texto completo de este artículo está disponible en PDF.Keywords : Diastolic heart failure, Digoxin, 30-day all-cause hospital admission
Esquema
| Funding: The Digitalis Investigation Group (DIG) study was conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) and the Department of Veterans Affairs Cooperative Studies Program, in collaboration with the DIG Investigators. This article was prepared using a limited access dataset obtained from the NHLBI and does not necessarily reflect the opinions or views of the DIG Study or the NHLBI. Dr. Ahmed was in part supported by the National Institutes of Health through grants (R01-HL085561, R01-HL085561-S and R01-HL097047) from the NHLBI. |
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| Conflict of Interest: None. Details of all financial disclosures of all authors have been submitted to the Journal. |
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| Authorship: AA conceived the study hypothesis and developed the analysis plan in consultation with coauthors. AA, SE, and TH wrote the first draft. AA, SE, TH, and KP conducted statistical analyses in collaboration with CJM, GM and GRC. All authors interpreted the data, participated in critical revision of the paper for important intellectual content, and approved the final version. AA, SE, TH, CJM, and KP had full access to the data. |
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| Embargoed materials: To be presented at a Late-Breaking Clinical Trials Poster Session and the Rapid Fire Oral Presentation Session at the 2013 Heart Failure Society of America 17th Annual Scientific Meeting on September 23, 2013 at Orlando, Florida. |
Vol 127 - N° 2
P. 132-139 - février 2014 Regresar al número
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