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Digoxin reduces hospital admissions in older patients with chronic heart failure


Digoxin significantly reduces the likelihood of hospital admission due to all causes among ambulatory older patients with chronic heart failure and reduced ejection fraction ( HFrEF ), according to research presented at the American College of Cardiology's 62nd Annual Scientific Session.

Researchers reviewed patient outcomes from 1995 in the Digitalis Investigation Group ( DIG ) trial of 6,800 patients with HFrEF, a condition in which the heart is too weak to pump and patients suffer from breathlessness and fatigue.
Patients with HFrEF are at high risk for hospitalization and rehospitalization.

The objective of the current study was to examine the effect of Digoxin on 30-day all-cause hospital admission among these patients, aged 21 to 94 years, half of whom were age 65 or older and would be Medicare eligible.

Data have shown Digoxin was associated with a 34% reduction in 30-day all-cause hospital admission. Digoxin is part of a group of drugs called positive inotropes that act to strengthen the heart muscle's contractions, thereby making the heart pump better. Unlike other positive inotropic drugs, Digoxin does not seem to increase mortality and has been found to block neurohormones in low doses. Experts say this is important as most drugs that reduce mortality and hospitalization in HFrEF also block neurohormones. This study found that treatment with Digoxin did not increase all-cause mortality during the first 30 days of follow-up.

While this study assessed rates of hospital admission in older ambulatory chronic heart failure patients, the researchers believe that these findings suggest that Digoxin may also help reduce readmission of older, acute heart failure patients recently discharged from a hospital.

This could be significant as earlier studies have found an estimated 27% of Medicare beneficiaries with heart failure return to the hospital within 30 days of discharge. One out of three of these readmissions is related to heart failure rather than other reasons.

Each time someone with heart failure goes to the hospital it also raises the risk of dying or having other poor outcomes. Because the present study draws on data from about 20 years ago, before the era of beta blockers and aldosterone antagonists, researchers say further research is needed to reevaluate Digoxin among contemporary heart failure patients and to assess its use before hospital discharge in the acute heart failure setting.

The Food and Drug Administration ( FDA ) approved oral Digoxin for the treatment of mild to moderate heart failure in 1997 following the DIG trial. ( Xagena )

Source: American College of Cardiology, 2013

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