Clinical research studyDigoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure
Section snippets
Data Source and Study Patients
The current study is based on the Alabama Heart Failure Project, the details of which have been described previously.21, 22 Briefly, 9649 medical records of 8555 unique fee-for-service Medicare beneficiaries discharged with a primary discharge diagnosis of heart failure from 106 Alabama hospitals between 1998 and 2001 were abstracted by trained technicians at the Clinical Data Abstraction Center. For patients with multiple hospitalizations, charts from the first hospitalization were used.23 A
Baseline Characteristics
Matched patients had a mean age (± SD) of 76 (± 11) years; 56% were women, and 25% were African American. Those receiving digoxin were more likely to be white men, have low ejection fraction and pulmonary edema, and receive diuretics and angiotensin-converting enzyme inhibitors on discharge (Table 1, Figure 1). These and other imbalances in baseline characteristics were attenuated to inconsequential levels after matching.
Digoxin and 30-Day All-Cause Hospital Readmission
During the 30 days after index hospitalization, all-cause hospital
Discussion
Findings from the current study demonstrate that among a well-balanced cohort of Medicare beneficiaries hospitalized for acute decompensation of heart failure, a new discharge prescription for digoxin was associated with a significant lower risk of 30-day all-cause hospital readmission. Digoxin use also was associated with a lower risk for all-cause readmission, heart failure readmission, all-cause mortality, and the combined end points at all times throughout the 12 months postdischarge,
Conclusions
Medicare beneficiaries with heart failure and reduced ejection fraction hospitalized for acute decompensation who received discharge prescriptions for digoxin had lower risk of 30-day all-cause hospital readmission. This benefit of digoxin extended throughout 12 months of follow-up and was not at the cost of higher mortality. Findings of efficacy of digoxin in reducing 30-day all-cause hospital admission in the DIG trial and clinical effectiveness to lower 30-day all-cause hospital readmission
References (51)
Heart failure in the lifetime of Musca domestica (the common housefly)
JACC Heart Fail
(2013)- et al.
Hospital strategies to reduce heart failure readmissions: where is the evidence?
J Am Coll Cardiol
(2012) A propensity matched study of New York Heart Association class and natural history end points in heart failure
Am J Cardiol
(2007)- et al.
A propensity-matched study of elevated jugular venous pressure and outcomes in chronic heart failure
Am J Cardiol
(2009) - et al.
Comparative hemodynamic and neurohormonal effects of intravenous captopril and digoxin and their combinations in patients with severe heart failure
J Am Coll Cardiol
(1989) - et al.
Double-blind placebo-controlled study of ibopamine and digoxin in patients with mild to moderate heart failure: results of the Dutch Ibopamine Multicenter Trial (DIMT)
J Am Coll Cardiol
(1993) - et al.
Digoxin reduces cardiac sympathetic activity in severe congestive heart failure
J Am Coll Cardiol
(1996) - et al.
Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: results of the PROVED trial. PROVED Investigative Group
J Am Coll Cardiol
(1993) - et al.
Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure
Am J Med
(2013) - et al.
Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry
J Am Coll Cardiol
(2009)
Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease
Am J Med
Renin-angiotensin inhibition in diastolic heart failure and chronic kidney disease
Am J Med
Baseline characteristics, quality of care, and outcomes of younger and older Medicare beneficiaries hospitalized with heart failure: findings from the Alabama Heart Failure Project
Int J Cardiol
Angiotensin-converting enzyme inhibitors and outcomes in heart failure and preserved ejection fraction
Am J Med
A propensity-matched study of outcomes of chronic heart failure (HF) in younger and older adults
Arch Gerontol Geriatr
Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: a retrospective analysis
J Am Coll Cardiol
Chronic heart failure in older adults
Med Clin North Am
Effectiveness of digoxin in reducing one-year mortality in chronic heart failure in the Digitalis Investigation Group trial
Am J Cardiol
Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry
J Am Coll Cardiol
Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge
J Am Coll Cardiol
Rehospitalizations among patients in the Medicare fee-for-service program
N Engl J Med
Hospitals face pressure to avert readmissions
The New York Times
Medicare Hospital Readmissions: Issues, Policy Options and PPACA
Interventions to reduce 30-day rehospitalization: a systematic review
Ann Intern Med
Cited by (0)
Funding: AA was in part supported by the National Institutes of Health (NIH) through grants (R01-HL085561, R01-HL085561-S, and R01-HL097047) from the National Heart, Lung, and Blood Institute and a generous gift from Ms. Jean B. Morris of Birmingham, AL. RMA is supported in part by grant number UL1 TR000165 from NIH.
Conflict of Interest: None.
Authorship: AA conceived the study hypothesis and design in collaboration with the coauthors. AA and KP wrote the first draft. AA and KP performed statistical analyses in collaboration with IBA, TEL, and CJM. All authors interpreted the data, participated in critical revision of the paper for important intellectual content, and approved the final version of the article. IBA, AA, CJM, and KP had full access to data.