Author + information
- Andrew P. Ambrosya,b,
- Ankeet Bhatta,b,
- Amanda Stebbinsa,b,
- Lisa Wrucka,b,
- Stephen Greenea,b,
- Marat Fudima,b,
- William Krausa,b,
- Christopher O'Connora,b,
- Ileana Pinaa,b,
- David Whellana,b and
- Robert Mentza,b
Background: Despite more than 200 years of clinical experience and a pivotal trial, recently published research has called into question the safety and efficacy of digoxin therapy in heart failure (HF).
Methods: HF-ACTION enrolled 2331 outpatients with HF and an EF <35% and randomized them to aerobic exercise training vs. usual care. The association between digoxin therapy and outcomes was assessed using Cox proportional hazard models.
Results: The prevalence of digoxin therapy decreased from 52% during the first 6 months of enrollment to 35% at the end of the HF-ACTION trial (p-value = <0.0001). Patients receiving digoxin at baseline tended to be younger and were more likely to report New York Heart Association functional class III/IV symptoms. Patients taking digoxin had worse exercise capacity as measured by peak VO2 and 6-minute walk test and greater impairments in health status as reflected by the Kansas City Cardiomyopathy Questionnaire. After adjusting for potential confounders, there was no association between digoxin therapy and the risk of death or hospitalization (Hazard Ratio 1.03, 95% Confidence Interval 0.92-1.16; p-value = 0.62) over a median follow-up duration of 3.7 years.
Conclusions: Although digoxin therapy was associated with high-risk clinical features, outcomes were similar after adjusting for known confounders. Additional prospective research is required to clarify the role of digoxin in contemporary clinical practice.
Moderated Poster Contributions
Heart Failure and Cardiomyopathies Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:15 a.m.-11:25 a.m.
Session Title: Why Can't We Be Friends? Controversies in Heart Failure Management
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1137M-13
- 2017 American College of Cardiology Foundation