P1497Digoxin in patients with advanced heart failure and sinus rhythm - Is there any benefit?

Abstract

Abstract Background Digoxin is one of the oldest drugs used in heart failure treatment. It is recommended in patients in sinus rhythm with still symptomatic heart failure with reduced ejection fraction. However, a controversy regarding digoxin use has risen with recent studies demonstrating an increased mortality and arrhythmias rate in patients taking this drug. Purpose The purpose of this study is to assess the prognostic impact of digoxin in patients in sinus rhythm with a CRT device, concerning all-cause mortality, hospitalizations due to acute heart failure and rate of ventricular arrhythmias. Methods A cohort of 297 consecutive P with advanced HF, sinus rhythm and a CRT device (80% with defibrillator) implanted between February 2004 and January 2016, in a single centre, was included in this retrospective study. Patients were divided in two groups regarding digoxin prescription (digoxin (DG) and without digoxin (NDG)). A mean clinical follow-up of 5.3 ± 3.4 years regarding long term outcomes was performed. Cox regression was used to identify independent predictors of outcomes. Results Digoxin was prescribed in 104 P (35%). In this cohort 67% of P were males and the mean age was 64 ± 11 years. Patients in DG were younger (60 ± 11 vs 66 ± 10, p < 0.001). The 2 groups had similar prevalence of comorbidities, with exception of chronic kidney disease (GD 27.5% vs GND 33.3%, p = 0.05). The etiology was similar between the 2 groups (42% ischaemic). In the qui-square analysis, there was a statically significant association between the use of digoxin and mortality (DG 42.3% vs NDG 25.4%, p= 0.003), and also between digoxin and hospitalization with acute heart failure (DG 36.5% vs NDG 21.4%, p = 0.005). There was no association between digoxin use and the occurrence of ventricular tachycardia (DG 31.7% vs 40.1%, p = 0.155). In the Cox proportional hazards regression, accounting for the potential confounders, the use of digoxin was an independent predictor for all-cause mortality (HR = 2.80, CI 95 [1.07 – 7.31], p = 0.036) and also for hospitalization with acute heart failure (HR = 5.82, CI 95 [1.54 – 22.06], p = 0.010). Conclusion The use of digoxin was an independent predictor of all-cause mortality and hospitalizations due to acute heart failure. Randomized trials are needed to clarify the impact of digoxin and determine if it is only an indicator of disease severity and worse prognosis or if the drug has a direct negative influence in the natural history of P with heart failure. Abstract Figure.