Digoxin is associated with worse outcomes in patients with heart failure with reduced ejection fraction

Jingmin Zhou, Juan Cao, Xuejuan Jin, Jun Zhou, Zhenyue Chen, Dingli Xu, Xinchun Yang, Wei Dong, Liwen Li, Yuyuan Fan, Li Chen, Qiaoqing Zhong, Micheal Fu, Kai Hu, Junbo Ge, CN-HF investigators, Jingmin Zhou, Juan Cao, Xuejuan Jin, Jun Zhou, Zhenyue Chen, Dingli Xu, Xinchun Yang, Wei Dong, Liwen Li, Yuyuan Fan, Li Chen, Qiaoqing Zhong, Micheal Fu, Kai Hu, Junbo Ge, CN-HF investigators

Abstract

Aims: The aim of this study was to investigate the impact of digoxin use on the outcomes of patients with heart failure with reduced ejection fraction (HFrEF) and its possible interaction with atrial fibrillation or use of currently guideline-recommended treatments in the real world in China.

Methods and results: Patients hospitalized with HFrEF from 45 hospitals participating in the China National Heart Failure Registration Study (CN-HF) were enrolled to assess the all-cause mortality, HF mortality, all-cause re-hospitalization, and HF re-hospitalization associated with digoxin use. Eight hundred eighty-two eligible HFrEF patients in the CN-HF registry were included: 372 patients with digoxin and 510 patients without digoxin. Among them, 794 (90.0%) patients were followed up for the endpoint events, with a median follow-up of 28.6 months. Kaplan-Meier survival analysis showed that the all-cause mortality (P < 0.001) and all-cause re-hospitalization (P = 0.020) were significantly higher in digoxin group than non-digoxin group, while HF mortality (P = 0.232) and HF re-hospitalization (P = 0.098) were similar between the two groups. The adjusted Cox proportional-hazards regression analysis demonstrated that digoxin use remained as an independent risk factor for increased all-cause mortality [hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.27-2.44; P = 0.001] and all-cause re-hospitalization (HR 1.27; 95% CI 1.03-1.57; P = 0.029) in HFrEF patients and the predictive value of digoxin for all-cause mortality irrespective of rhythm or in combination with other guideline-recommended therapies.

Conclusions: Digoxin use is independently associated with increased risk of all-cause mortality and all-cause re-hospitalization in HFrEF patients.

Trial registration: ClinicalTrials.gov NCT02079428.

Keywords: Atrial fibrillation; Digoxin; Heart failure; Prognosis.

Conflict of interest statement

None declared.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Figures

Figure 1
Figure 1
Flowchart of the study population. LVEF, left ventricular ejection fraction.
Figure 2
Figure 2
Kaplan–Meier cumulative risk of all‐cause mortality in patients with and without digoxin.
Figure 3
Figure 3
Kaplan–Meier cumulative risk of all‐cause re‐hospitalization in patients with and without digoxin.

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Source: PubMed

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