Use of digoxin and risk of death or readmission for heart failure and sinus rhythm: A nationwide propensity score matched study

Abstract

Background/objectives: Digoxin is widely used as symptomatic treatment in heart failure (HF), but the role in contemporary treatment of HF with sinus rhythm (SR) is debatable. We investigated the risk of death and hospital readmission, according to digoxin use, in a nationwide cohort of digoxin-naïve patients with HF and SR.

Methods: From Danish nationwide registries, digoxin-naïve HF patients from 1996 to 2012 were identified. Patients with cardiac dysrhythmias or use of warfarin were excluded. Digoxin users and non-users were compared in propensity matched cox regression models with respect to primary outcomes of all-cause mortality and HF readmission.

Results: The study population comprised 5327 digoxin users and 10,654 matched non-users with a median age of 77. During follow-up 10,643 (66.6%) patients died and 7584 (47.5%) patients were readmitted due to HF. Use of digoxin was associated with increased risk of death (hazard ratio (HR): 1.19, 95%-CI: 1.15-1.24) and increased risk of HF readmission (HR: 1.19, 95%-CI: 1.13-1.25). Cumulative incidences of readmission, considering death as a competing risk was 50% for digoxin users and 47% for non-users. The associations applied regardless of concomitant HF treatment. In an exploratory analysis considering patients with previous digoxin use, no effect on mortality (HR: 1.00, 95%-CI: 0.94-1.06), nor on HF readmission (HR: 1.00, 95%-CI: 0.93-1.09) was observed.

Conclusion: In chronic HF with SR, digoxin was associated with a slightly increased risk of death and was not associated with decreased HF readmission rates.

Keywords: Digoxin; Heart failure; Mortality risk; Readmission; Sinus rhythm.