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  • Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure.

Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure.

The American journal of medicine (2013-11-22)
Ali Ahmed, Robert C Bourge, Gregg C Fonarow, Kanan Patel, Charity J Morgan, Jerome L Fleg, Inmaculada B Aban, Thomas E Love, Clyde W Yancy, Prakash Deedwania, Dirk J van Veldhuisen, Gerasimos S Filippatos, Stefan D Anker, Richard M Allman
ABSTRACT

Heart failure is the leading cause for hospital readmission, the reduction of which is a priority under the Affordable Care Act. Digoxin reduces 30-day all-cause hospital admission in chronic systolic heart failure. Whether digoxin is effective in reducing readmission after hospitalization for acute decompensation remains unknown. Of the 5153 Medicare beneficiaries hospitalized for acute heart failure and not receiving digoxin, 1054 (20%) received new discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 5153 patients, were used to assemble a matched cohort of 1842 (921 pairs) patients (mean age, 76 years; 56% women; 25% African American) receiving and not receiving digoxin, who were balanced on 55 baseline characteristics. Thirty-day all-cause readmission occurred in 17% and 22% of matched patients receiving and not receiving digoxin, respectively (hazard ratio [HR] for digoxin, 0.77; 95% confidence interval [CI], 0.63-0.95). This beneficial association was observed only in those with ejection fraction <45% (HR 0.63; 95% CI, 0.47-0.83), but not in those with ejection fraction ≥ 45% (HR 0.91; 95% CI, 0.60-1.37; P for interaction, .145), a difference that persisted throughout the first 12 months postdischarge (P for interaction, .019). HRs (95% CIs) for 12-month heart failure readmission and all-cause mortality were 0.72 (0.61-0.86) and 0.83 (0.70-0.98), respectively. In Medicare beneficiaries with systolic heart failure, a discharge prescription of digoxin was associated with lower 30-day all-cause hospital readmission, which was maintained at 12 months, and was not at the expense of higher mortality. Future randomized controlled trials are needed to confirm these findings.

MATERIALS
Product Number
Brand
Product Description

Supelco
Digoxin solution, 1.0 mg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®
Digoxin for peak identification, European Pharmacopoeia (EP) Reference Standard
Supelco
Digoxin, certified reference material, TraceCERT®, Manufactured by: Sigma-Aldrich Production GmbH, Switzerland
Supelco
Digoxin, analytical standard
Digoxin, European Pharmacopoeia (EP) Reference Standard