Digoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure

作者：Ahmed Ali^*; Bourge Robert C; Fonarow Gregg C; Patel Kanan; Morgan Charity J; Fleg Jerome L; Aban Inmaculada B; Love Thomas E; Yancy Clyde W; Deedwania Prakash; van Veldhuisen Dirk J; Filippatos Gerasimos S; Anker Stefan D; Allman Richard M

来源：American Journal of Medicine, 2014, 127(1): 61-70.

DOI：10.1016/j.amjmed.2013.08.027

• Digoxin
• Heart failure
• Hospital readmission

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.

• 出版日期2014-1
• 单位西北大学