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Am J Med. 2014 Jan;127(1):61-70. doi: 10.1016/j.amjmed.2013.08.027. Epub 2013 Nov 18.

Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure.

Author information

1
University of Alabama at Birmingham, Birmingham, Ala; Veterans Affairs Medical Center, Birmingham, Ala. Electronic address: aahmed@uab.edu.
2
University of Alabama at Birmingham, Birmingham, Ala.
3
University of California, Los Angeles, Calif.
4
National Heart, Lung, and Blood Institute, Bethesda, Md.
5
Case Western Reserve University, Cleveland, Ohio.
6
Northwestern University, Chicago, Ill.
7
University of California, San Francisco, Fresno, Calif.
8
University of Groningen, Groningen, the Netherlands.
9
Attikon University Hospital, Athens, Greece.
10
Applied Cachexia Research, Charité, Campus Virchow-Klinikum, Berlin, Germany.
11
University of Alabama at Birmingham, Birmingham, Ala; Veterans Affairs Medical Center, Birmingham, Ala.

Abstract

BACKGROUND:

Heart failure is the leading cause for hospital readmission, the reduction of which is a priority under the Affordable Care Act. Digoxin reduces 30-day all-cause hospital admission in chronic systolic heart failure. Whether digoxin is effective in reducing readmission after hospitalization for acute decompensation remains unknown.

METHODS:

Of the 5153 Medicare beneficiaries hospitalized for acute heart failure and not receiving digoxin, 1054 (20%) received new discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 5153 patients, were used to assemble a matched cohort of 1842 (921 pairs) patients (mean age, 76 years; 56% women; 25% African American) receiving and not receiving digoxin, who were balanced on 55 baseline characteristics.

RESULTS:

Thirty-day all-cause readmission occurred in 17% and 22% of matched patients receiving and not receiving digoxin, respectively (hazard ratio [HR] for digoxin, 0.77; 95% confidence interval [CI], 0.63-0.95). This beneficial association was observed only in those with ejection fraction <45% (HR 0.63; 95% CI, 0.47-0.83), but not in those with ejection fraction ≥ 45% (HR 0.91; 95% CI, 0.60-1.37; P for interaction, .145), a difference that persisted throughout the first 12 months postdischarge (P for interaction, .019). HRs (95% CIs) for 12-month heart failure readmission and all-cause mortality were 0.72 (0.61-0.86) and 0.83 (0.70-0.98), respectively.

CONCLUSIONS:

In Medicare beneficiaries with systolic heart failure, a discharge prescription of digoxin was associated with lower 30-day all-cause hospital readmission, which was maintained at 12 months, and was not at the expense of higher mortality. Future randomized controlled trials are needed to confirm these findings.

KEYWORDS:

Digoxin; Heart failure; Hospital readmission

PMID:
24257326
PMCID:
PMC3929967
DOI:
10.1016/j.amjmed.2013.08.027
[Indexed for MEDLINE]
Free PMC Article

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