Digoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure

• Published in: The American journal of medicine Vol. 127; no. 1; pp. 61 - 70
• Main Authors: Ahmed, Ali, MD, MPH, Bourge, Robert C., MD, Fonarow, Gregg C., MD, Patel, Kanan, MBBS, MPH, Morgan, Charity J., PhD, Fleg, Jerome L., MD, Aban, Inmaculada B., PhD, Love, Thomas E., PhD, Yancy, Clyde W., MD, Deedwania, Prakash, MD, van Veldhuisen, Dirk J., MD, PhD, Filippatos, Gerasimos S., MD, PhD, Anker, Stefan D., MD, PhD, Allman, Richard M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2014; Elsevier Sequoia S.A
• Subjects: Aged; Aged, 80 and over; Beneficiaries; Cardiotonic Agents - administration & dosage; Case-Control Studies; Chronic Disease; Digoxin; Digoxin - administration & dosage; Drug Administration Schedule; Drug use; Female; Heart failure; Heart Failure, Systolic - drug therapy; Heart Failure, Systolic - epidemiology; Hospital readmission; Humans; Internal Medicine; Male; Medical research; Medicare; Patient admissions; Patient Discharge; Patient Readmission - statistics & numerical data; Treatment Outcome; United States - epidemiology; United States; Heart failure; Digoxin; Hospital readmission
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2013.08.027

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.