Digoxin use and lower risk of 30-day all-cause readmission in older patients with heart failure and reduced ejection fraction receiving -blockers

BackgroundDigoxin use has been associated with a lower risk of 30-day all-cause admission and readmission in patients with heart failure and reduced ejection fraction (HFrEF). HypothesisDigoxin use will be associated with improved outcomes in patients with HFrEF receiving -blockers. MethodsOf the 3076 hospitalized Medicare beneficiaries with HFrEF (EF <45%), 1046 received a discharge prescription for -blockers, of which 634 were not on digoxin. Of the 634, 204 received a new discharge prescription for digoxin. Propensity scores for digoxin use, estimated for each of the 634 patients, were used to assemble a matched cohort of 167 pairs of patients receiving and not receiving digoxin, balanced on 30 baseline characteristics. Matched patients (n=334) had a mean age of 74years and were 46% female and 30% African American. Results30-day all-cause readmission occurred in 15% and 27% of those receiving and not receiving digoxin, respectively (hazard ratio [HR]: 0.51, 95% confidence interval [CI]: 0.31-0.83, P=0.007). This beneficial association persisted during 4years of follow-up (HR: 0.72, 95% CI: 0.57-0.92, P=0.008). Digoxin use was also associated with a lower risk of the combined endpoint of all-cause readmission or all-cause mortality at 30days (HR: 0.54, 95% CI: 0.34-0.86, P=0.009) and at 4years (HR: 0.76, 95% CI: 0.61-0.96, P=0.020). ConclusionsIn hospitalized patients with HFrEF receiving -blockers, digoxin use was associated with a lower risk of 30-day all-cause readmission but not mortality, which persisted during longer follow-up.