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Home Newsletters NL-1-2014-LETTER-11- DIGOXIN ASSOCIATED WITH HIGHER RISK OF DEATH IN PATIENTS WITH SYSTOLIC HF
NL-1-2014-LETTER-11- DIGOXIN ASSOCIATED WITH HIGHER RISK OF DEATH IN PATIENTS WITH SYSTOLIC HF PDF Print E-mail

 

 

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DIGOXIN ASSOCIATED WITH HIGHER RISK OF DEATH IN PATIENTS WITH SYSTOLIC HF

Sarumathy S, Dr.V.Ravichandiran , Samuel Gideon George P

Department of Pharmacy Practice, School of Pharmaceutical Sciences, Vels University

 

Digoxin, the cardiac glycoside used in the treatment of Congestive Cardiac Failure, was found to be associated with 72 percent higher rate of death among adults with newly diagnosed systolic heart failure(SHF), according to a study published in the current online issue of Circulation: Cardiovascular Quality and Outcomes1,2.

The results of this study contrast with the findings of a randomized trial by the Digitalis Investigation Group conducted between 1991 and 1993, which showed that digoxin did not lower mortality among therapy patients with systolic heart failure (HF), a malfunction in the way the left ventricle of the heart pumps blood. Following the group’s study, professional societies issued clinical guidelines endorsing the use of digoxin for patients with systolic dysfunction.

The current study was conducted among 2,891 adults within Kaiser Permanente in Northern California who had newly diagnosed systolic heart failure between 2006 and 2008 and no prior digoxin use. Eighteen percent of the participants initiated digoxin during the study period.

Researchers followed the patients through December 31, 2010, to evaluate the effectiveness and safety of digoxin therapy. They found that digoxin use was associated with higher mortality but no significant difference in the risk of heart failure hospitalization. There were a total of 801 deaths (737 off digoxin and 64 on digoxin). After adjustment for potential confounders, digoxin use was associated with a 72 percent higher relative rate of death. There were 1,723 hospitalizations for heart failure overall (1,596 off digoxin, 127 on digoxin). However, after adjustment for potential confounders, digoxin use was not significantly associated with hospitalization for heart failure.

Adults identified with incident systolic HF between 2006 and 2008 who had no prior digoxin use was chosen. Multivariable extended Cox regression was used to examine the association between new digoxin use and risks of death and HF hospitalization, controlling for medical history, laboratory results, medications, HF disease severity, and the propensity for digoxin use. Analyses stratified by sex and concurrent β-blocker use were also conducted. Among 2891 newly diagnosed patients with systolic HF, 529 (18%) received digoxin. During a median 2.5 years of follow-up, incident digoxin use was associated with higher rates of death (14.2 versus 11.3 per 100 person-years) and HF hospitalization (28.2 versus 24.4 per 100 person-years). In multivariable analysis, incident digoxin use was associated with higher mortality (hazard ratio, 1.72; 95% confidence interval, 1.25–2.36) but no significant difference in the risk of HF hospitalization (hazard ratio, 1.05; 95% confidence interval, 0.82–1.34). Results were similar in analyses stratified by sex and β-blocker use.

Conclusion:

Digoxin use in patients with incident systolic HF was independently associated with a higher risk of death but no difference in HF hospitalization.

Reference:

1. Freeman JV, Yang J, Sung SH, Hlatky MA, Go AS. Effectiveness and Safety of Digoxin among contemporary adults with incident Systolic Heart Failure. Circulation: Cardiovascular Quality and Outcomes, 2013; 6 (5): 525

2. http://www.dor.kaiser.org/external/news/press_releases/Use_of_Digoxin_Associated_with_Higher_Risk_of_Death_for_Patients/

 

 

 

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