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ORIGINAL ARTICLE
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 29-35

Impact of digoxin on all-cause mortality and re-hospitalizations in acute heart failure patients

Mohammed Al-Jarallah1, Rajesh Rajan1, Ibrahim Al-Zakwani2, Raja Dashti1, Bassam Bulbanat1, Mustafa Ridha3, Kadhim Sulaiman4, Alawi A Alsheikh-Ali5, Prashanth Panduranga6, Khalid F AlHabib7, Jassim Al Suwaidi8, Wael Al-Mahmeed9, Hussam AlFaleh7, Abdelfatah Elasfar10, Ahmed Al-Motarreb11, Nooshin Bazargani12, Nidal Asaad13, Haitham Amin14
1 Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Kuwait City, Kuwait
2 Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman & Gulf Health Research, Muscat, Oman
3 Division of Cardiology, Al-Dabous Cardiac Centre, Al Adan Hospital, Kuwait City, Kuwait
4 Department of Cardiology, Royal Hospital, and Director General of Specialized Medical Care, Ministry of Health, Muscat, Oman
5 College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
6 Department of Cardiology, Royal Hospital, Muscat, Oman
7 Department of Cardiac Sciences, King Fahad Cardiac Centre, King Saud University, Riyadh, Saudi Arabia
8 Department of Adult Cardiology, Hamad Medical Corporation and Qatar Cardiovascular Research Centre, Doha, Qatar
9 Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
10 Department of Adult Cardiology, King Salman Heart Centre, King Fahad Medical City, Riyadh, Saudi Arabia; Cardiology Department, Tanta University, Tanta, Egypt
11 Department of Internal Medicine, Faculty of Medicine, Sana'a University, Sana'a, Yemen
12 Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
13 Department of Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
14 Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain

Correspondence Address:
Dr. Rajesh Rajan
Department of Cardiology, Sabah Al-Ahmad Cardiac Centre, Kuwait City
Kuwait
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ACCJ.ACCJ_1_20

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Background and Objectives: The use of digoxin in acute heart failure (AHF) is not without controversy. The aim of this study was to examine the impact of digoxin therapy on all-cause mortality and re-hospitalizations for heart failure (HF) at 3 months and 12 months in AHF patients in the Arabian Gulf stratified by left ventricular ejection fraction (EF). Methods: Data were analyzed from 4577 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries with AHF from February to November, 2012. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 59 ± 15 years, and 63% (n = 2887) were males. At hospital discharge, digoxin was prescribed to 25% (n = 1156) of the patients. Nearly 59% (n = 2683) of the patients had HF with reduced EF (HFr EF) (<40%), 21% (n = 962) had HF with mid-range EF (HFmr EF) (40%–49%), and 20% (n = 932) had HF with preserved EF (HFp EF) (≥50%). The most prominent comorbidities included hypertension (61%; n = 2783), coronary artery disease (60%; n = 2762), and diabetes mellitus (49%; n = 2258). Multivariate logistic regression analysis demonstrated that digoxin use was associated with lower cumulative all-cause mortality at 3-month (adjusted odds ratio [aOR]: 0.57; 95% confidence interval [CI]: 0.41–0.79; P = 0.001) and at 12-month (aOR: 0.74; 95% CI: 0.58–0.96; P = 0.021) follow-up post hospital discharge in patients with HFr EF. There was, however, no survival advantage conferred by digoxin use in those with HFmr EF or HFp EF, at either the 3-month or 12-month follow-up (all P > 0.05). Digoxin use was also not associated with any benefits regarding re-hospitalization for HF at either 3 months or at 12 months in any type of HF (all P > 0.05). Conclusions: Digoxin was associated with lower cumulative all-cause mortality at both 3-month and 12-month follow-ups in AHF patients with reduced EF in the Arabian Gulf. However, digoxin use did not offer any survival advantages in those with HFmr EF and HFp EF after either 3 months or 12 months. Digoxin use was also not associated with any benefits toward re-hospitalizations for HF at a 3-month or 12-month follow-up in AHF patients.


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