Digoxin significantly reduces the likelihood of hospital admission due to all causes among ambulatory older patients with chronic heart failure and reduced ejection fraction (HFrEF), according to research presented today at the American College of Cardiology's 62nd Annual Scientific Session.
Researchers reviewed patient outcomes from 1995 in the Digitalis Investigation Group (DIG) trial of 6,800 patients with HFrEF-a condition in which the heart is too weak to pump and patients suffer from breathlessness and fatigue. Patients with HFrEF are at high risk for hospitalization and rehospitalization. The objective of the current study was to examine the effect of digoxin on 30-day all-cause hospital admission among these patients, aged 21 to 94 years, half of whom were age 65 or older and would be Medicare eligible.
Data show digoxin was associated with a 34 percent reduction in 30-day all-cause hospital admission. Digoxin is part of a group of drugs called positive inotropes that act to strengthen the heart muscle's contractions, thereby making the heart pump better. Unlike other positive inotropic drugs, digoxin does not seem to increase mortality and has been found to block neurohormones in low doses. Experts say this is important as most drugs that reduce mortality and hospitalization in HFrEF also block neurohormones. This study found that treatment with digoxin did not increase all-cause mortality during the first 30 days of follow-up.
"We have an approved drug, which is inexpensive, generally well-tolerated and known to reduce the long-term risk of hospitalization due to heart failure, that has now been demonstrated to reduce hospital admissions due to all causes within the first 30 days of use," said Ali Ahmed, MD, MPH, professor of medicine and epidemiology in the UAB Divisions of Geriatrics and Cardiology and Birmingham VA Medical Center, and the study's lead investigator.
While this study assessed rates of hospital admission in older ambulatory chronic heart failure patients, the researchers believe that these findings suggest that digoxin may also help reduce readmission of older, acute heart failure patients recently discharged from a hospital.
"Because the effect of digoxin was more pronounced in high-risk sicker subgroups, such as those with New York Heart Association class III or IV symptoms or an enlarged heart, the kind of patients who were at a higher risk of hospital admission, and because of digoxin's favorable influence on heart pump and blood flow, it may be expected that digoxin would also be effective in patients who were recently hospitalized for acute heart failure as they have very high risk for re-admission," Dr. Ahmed said.
This could be significant as earlier studies have found an estimated 27 percent of Medicare beneficiaries with heart failure return to the hospital within 30 days of discharge. All told, nearly one out of three of these readmissions is related to heart failure rather than other reasons.