A Comparison of Digitalis use on Mortality and Morbidity among Special Populations with Heart Failure Reduced Ejection Fractions

Abstract

Introduction The DIG trial introduced the benefit of digitalis (dig) in HFrEF, a reduction in HF hospitalizations. However, the study consisted of less than 15% nonwhite patients, making generalizability difficult. Genetic polymorphisms have been described to add variability in drug responses for varying races. No studies have compared outcomes of dig use among races. In this study, we assessed the effect of dig use on the length of hospitalization, readmission rates, and mortality in different racial groups with HFrEF. Method A retrospective cohort study of 1,047 patients admitted from 2005-2014 with decompensated HFrEF. Patients were split into three groups, Hispanic, African American (AA), and Caucasian. The primary outcomes of interest at 1, 6 and 12 months were length of hospital stay, readmission rates, and overall mortality. Results Out of 1,047 HFrEF patients, 244 patients were on dig treatment and 803 patients were not. There was racial discordance among groups; AA and Hispanics were more likely to receive dig compared to Caucasians. There was no difference among the Caucasian group with or without dig. Among the Hispanic group who received dig, they had lower ejection fractions (EF), higher 30-day, 6 month, and 1-year readmission rates compared to the non-dig group. Among the AA group, the dig group was composed of lower EF and had lower 30-day, 6 month and 1-year readmission rates compared to non-dig group. However, readmission rates were not statistically significant. Conclusion Our study concluded that among HFrEF patients, Hispanics had worse outcomes with dig use while Caucasians had no difference. In the AA group, dig use had lower EF but insignificantly lower 30-day, 6 month and 1 year readmission rates. However, our study may suggest benefit in AA. More trials assessing dig are needed in these populations to effectively manage the mortality and morbidity of HFrEF.