Digoxin therapy and the risk of primary cardiac arrest in patients with congestive heart failure: Effect of mild–moderate renal impairment

Abstract

Background and Objective: The cardiac safety of digoxin therapy for congestive heart failure (CHF) is a source of concern, especially among those with renal impairment. Methods: Using a case–control design, we examined the risk of primary cardiac arrest (PCA) associated with digoxin therapy within three levels of renal function. Results: After adjustment for other clinical characteristics, digoxin therapy for CHF was not associated with an increased risk of PCA [odds ratio (OR) = 0.97, 95% confidence interval (CI) 0.59–1.62] among patients with normal renal function (serum creatinine ⩽1.1 mg/dL). In contrast, digoxin therapy was associated with a modest increase in risk (OR = 1.58, CI 0.89–2.80) among patients with mild renal impairment (serum creatinine = 1.2–1.4 mg/dL); and a twofold increase in risk (OR = 2.39, CI 1.37–4.18) among patients with moderate renal impairment (serum creatinine = 1.5–3.5 mg/dL). Conclusions: These findings suggest that the risks of digoxin may offset the benefits among patients with moderately impaired renal function, but not among patients with normal renal function.