Digoxin is Associated with Higher Quality of Life in LVAD Recipients

Abstract

Purpose To examine the effects of digoxin on functional capacity and quality of life as measured by the 6-minute walk test (6MWT) and Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ) in patients receiving the Heartware HVAD system. Methods HVAD patients who remained alive on device support at 6 months from the ADVANCE + CAP, ENDURANCE + Supplemental trials were eligible. Pts were separated by digoxin use: those who were discharged from the index hospitalization on digoxin and remained on digoxin through 6 months (DIG, n=161) and those discharged from the index hospitalization not on digoxin and remained off through 6 months (NO DIG, n=533). Differences in 6MWT and KCCQ were compared between groups at baseline, 6, and 12 months. Adverse events were compared between groups from baseline through 6 months. Results Baseline characteristics were similar: Mean age was 59 years and 23% of patients were female. Serum creatinine was 0.9mg/dL ± 0.7. History of atrial fibrillation was more common in the DIG group (57.8% vs 42.9%, p = 0.001). Compared to the NO DIG group, the DIG group had greater improvements in KCCQ score at 6 months (+ 36.8 vs. + 27.7, p=0.0001) and at 12 months (+35.9 vs +29.5, p=0.01). 6MWT was similar between groups (Table 1). Device malfunction within 6 months was more common in the DIG group [18% (0.42 EPPY) vs 9.2% (0.21 EPPY), p = 0.002]. Rates of other adverse events including 6-month re-hospitalization [47.8% (2.21 EPPY) vs 42.9% (1.8 EPPY), p=0.10] were similar. Conclusion LVAD recipients maintained on chronic digoxin for at least 6 mo had greater improvements in QOL scores compared to those not treated with digoxin despite having higher rates of device malfunction and similar improvements in functional capacity. Prospective study is warranted.