Published Online
on February 10, 2009

A more recent version of this article appeared on March 1, 2009

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Original Article

Digoxin Therapy Does Not Improve Outcomes in Patients with Advanced Heart Failure on Contemporary Medical Therapy

Vasiliki Georgiopoulou; Andreas Kalogeropoulos; Grigorios Giamouzis; Syed Agha; Mohammad Rashad; Sana Waheed; Sonjoy Laskar; Andrew Smith and Javed Butler¹

Emory University

¹ E-mail: javed.butler{at}emory.edu

Background—The impact of digoxin on outcomes of advanced heart failure (HF) patients receiving optimal contemporary therapy is not known.

Methods and Results—We retrospectively reviewed data on 455 advanced HF patients referred for transplant evaluation (age 52±12years, ejection fraction 18.3±8%); 227 (49.9%) were on digoxin at baseline. Primary outcome was death (n=101), urgent transplantation (n=14), or ventricular assist device implantation (n=4); secondary outcomes included HF- and all-cause hospitalizations. Digoxin use was evaluated a) in the original cohort; b) in a propensity score matched subset (n=322); c) as time-dependent covariate; and d) after adjustment for Seattle Heart Failure Score (SHFS). Patients were on optimal therapy: angiotensin-II modulation 92.5%, beta-blockers 91.2%, aldosterone antagonists 45.6%; devices 71.0%. After a median of 27 months, 83/277 (36.6%) patients treated with digoxin vs. 36/228 (15.8%) without digoxin met primary outcome (HR 2.28, 95% CI, 1.51-3.43, P<0.001); this risk persisted in the matched subset (HR 1.73, 95% CI, 1.09-2.75, P=0.021) and with time-varying digoxin use (HR 2.05, 95% CI, 1.23-3.41, P=0.011). Digoxin was associated with higher risk among patients in sinus rhythm compared to atrial fibrillation. Digoxin was not associated with improvement in either all-cause or HF hospitalization rates. These results were similar across gender and race, and when adjusted for SHFS and renal function.

Conclusion—This study suggests that digoxin therapy may be of no benefit in advanced HF patients referred for cardiac transplantation who received optimal medical therapy. Treatment with digoxin should be used cautiously in such patients because of risk for adverse outcomes

Key Words: heart failure • digoxin • outcomes • prognosis

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Digoxin Therapy Does Not Improve Outcomes in Patients With Advanced Heart Failure on Contemporary Medical Therapy

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This article has been cited by other articles:

				J. G.F. Cleland and D. Cullington Digoxin: Quo Vadis? Circ Heart Fail, March 1, 2009; 2(2): 81 - 85. [Full Text] [PDF]