The Reply

Abstract

We thank Temtanakitpaisan et al for their interest and agree that newer randomized control trials of digoxin in contemporary patients with systolic heart failure may be needed for clinical practice to change.1Douglas D. Digoxin may cut heart failure readmission in the elderly. Available at: http://www.thedoctorschannel.com/view/digoxin-may-cut-heart-failure-readmission-in-the-elderly/.Google Scholar The efficacy of digoxin in reducing the risk of hospitalization due to worsening heart failure was clearly established in the Digitalis Investigation Group trial, and this effect has been shown to be more pronounced in those in the high-risk subgroup.2Gheorghiade M. Patel K. Filippatos G. et al.Effect of oral digoxin in high-risk heart failure patients: a pre-specified subgroup analysis of the DIG trial.Eur J Heart Fail. 2013; 15: 551-559Crossref PubMed Scopus (66) Google Scholar We have demonstrated that the effect of digoxin on hospital admission is early and broad, resulting in a significant reduction in the risk of 30-day all-cause admission in systolic heart failure,3Bourge R.C. Fleg J.L. Fonarow G.C. et al.Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure.Am J Med. 2013; 126: 701-708Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar but not in diastolic heart failure.4Hashim T. Elbaz S. Patel K. et al.Digoxin and 30-day all-cause hospital admission in older patients with chronic diastolic heart failure.Am J Med. 2014; 127: 132-139Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar We also have demonstrated that digoxin use is associated with lower 30-day all-cause readmission in real-world patients with systolic heart failure,5Ahmed A. Bourge R.C. Fonarow G.C. et al.Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure.Am J Med. 2014; 127: 61-70Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar including those receiving beta-blockers.6Hashim T. Parvataneni S. Fonarow G.C. et al.Discharge initiation of digoxin is associated with lower 30-day all-cause readmission in hospitalized older patients with heart failure and reduced ejection fraction receiving beta-blockers.Circulation. 2013; 128: A16811Google Scholar Heart failure is the leading cause for 30-day all-cause readmission. Under pressure to avoid cuts in Medicare payments because of above-average 30-day all-cause readmission mandated by the Affordable Care Act, hospitals are adopting various transition of care strategies based on single-center reports, post hoc analyses, observational studies, and expert opinion. Despite limitations of the cost-driven metric of 30-day all-cause hospital readmission, the fact remains that one quarter of hospitalized patients with heart failure are readmitted within 30 days of hospital discharge. On the basis of the totality of existing evidence, we believe that it is reasonable for physicians to consider digoxin for patients with heart failure and ejection fraction <45% to reduce 30-day all-cause hospital readmission. Use of Digoxin in Chronic Systolic Heart Failure in Current EraThe American Journal of MedicineVol. 128Issue 1PreviewWe thank Bourge et al1 for their article titled “Digoxin Reduces 30-day All-cause Hospital Admission in Older Patients with Chronic Systolic Heart Failure,” which was published in The American Journal of Medicine. The authors demonstrated benefit of digoxin in reduction of 30-day all-cause hospital admission based on the main Digitalis Investigation Group (DIG) trial. This is very relevant in the current era because heart failure is a leading cause of hospitalization and re-hospitalization in the elderly. Full-Text PDF