Background: In patients with heart failure (HF), digoxin reduces the risk of 30-day all-cause readmission (PMCID: PMC3929967). In the current study, we examined if digoxin use is associated with lower 30-day all-cause readmission in hospitalized patients with HF and reduced EF (HFrEF) receiving beta-blockers (BBs).
Methods: In the Medicare-linked OPTIMIZE-HF registry, of the 10625 hospitalized patients with HFrEF (EF ≤40%), 7601 received a discharge prescription for BBs. We restricted our analysis to an inception cohort of 5307 patients who were not receiving digoxin on admission. Of these, 1075 received a new discharge prescription for digoxin. Propensity scores for digoxin use, estimated for each of the 5307 patients, were used to assemble a cohort of 1043 pairs of patients, receiving and not receiving digoxin, balanced on 46 baseline characteristics. All results are based on 2086 matched patients who had a mean (±SD) age of 75 (±11) years and EF of 25 (±8) percent, 42% were women, and 13% African American.
Results: Digoxin use was associated with a lower risk of HF readmission (HR, 0.85; 95% CI, 0.73-0.98), all-cause readmission (HR, 0.90; 95% CI, 0.80-0.997), combined endpoint of all-cause readmission or mortality (HR, 0.90; 95% CI, 0.82-0.998) at 1 year, but not all-cause mortality (HR, 1.03; 95% CI, 0.87-1.21). HRs (95% CIs) for all-cause and HF readmission and all-cause mortality at 30 days were 0.88 (0.73-1.06), 0.74 (0.55-0.996), and 0.79 (0.54-1.14), respectively.
Conclusion: In older patients with HFrEF receiving BBs, discharge initiation of digoxin appear to be associated with a lower risk of all-cause and HF readmission, but not of mortality.