Effect of Digoxin on Clinical Outcomes in Patients on Contemporary Heart Failure Therapy

S100 Journal of Cardiac Failure Vol. 14 No. 6S Suppl. 2008 of Nursing, Emory University, Atlanta, GA; 2Center for Heart Failure Therapy, EmoryHealthCare, Atlanta, GA; 3Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA Background: HF patients with diabetes mellitus (DM) have increased rehospitalizations and mortality. HF patients with DM also have demanding self care regimens related to diet, medications, physical activity, and symptoms. This project compared HF patients with (HF-DM) and without (HF no-DM) diabetes mellitus on demographic and clinical factors, HF self care behaviors, and outcomes. Methods: NYHA Class II & III HF patients (n 5 97), age 56.2 6 10.1 yrs, 65% men, 58% minority participated. LVEF, # of medications & comorbidities, BMI and serum BNP were obtained. Other variables were HF knowledge (EHFKT); self efficacy (Perceived Competence Diet and Medication Scales); self care behaviors of diet (3 day food record, 24 hour urinary sodium) and medication taking (MEMS). Outcomes were functional status (6MWT) and quality of life (Minnesota Living with Heart Failure Questionnaire; MLHFQ). Data were analyzed by comparing HF-DM with HF noDM patients using t-tests, Chi square, and ANOVA. Results: DM was present in 38% (n 5 37) for a median of 12 years. HF-DM differed from HF no-DM on age (59 6 7 vs 54 6 11 years, p 5 .04), # of comorbidities (3.1 vs 2.1, p!.01), # of medications (12 6 4 vs 9 6 3, p5.002), BMI (35.2 6 7 vs 31.5 6 9, p5.04) and serum BNP levels (143 6 154 vs 291 6 400, p5.03). No differences were found in LVEF, HF knowledge, self efficacy, or percent medications taken. Although not statistically significant, HF-DM patients consumed 400 mg more of sodium per day, had lower 6MWT distance and higher MLHFQ scores than the HF no-DM group. HF-DM patients had more hospitalizations (1.63 6 3.5 vs. .65 6.98, p5.05) in the preceding 4 months. Conclusions: HF-DM were older, had more comorbidities and medications than HF no-DM. HF patients with and without DM had equivalent knowledge, self efficacy for diet and medications, HF medication adherence, yet HF-DM patients consumed more dietary sodium which may be clinically relevant. HF-DM had greater BMI and lower serum BNP levels, slightly lower functional status, worse quality of life scores, and greater health resource use. These data suggest that patient education should emphasize dietary sodium for HF-DM patients. Greater understanding of patient and clinical factors, self care behaviors and outcomes in HF patients with comorbidities is needed.

326 Effect of Digoxin on Clinical Outcomes in Patients on Contemporary Heart Failure Therapy Amandeep S. Dhaliwal1,2, Blaise Carabello1,2, Audrius Bredikis1,2, Gabriel Habib1,2, Kumudha Ramasubbu1,2, Biykem Bozkurt1,2; 1Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX; 2Division of Cardiology, Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX Background: Previous trials have shown that digoxin is beneficial in subjects with heart failure (HF). However, these studies were conducted before the incorporation of beta-blockers as standard therapy for HF. There are limited data on the effect of digoxin in HF patients on a contemporary regimen of renin-angiotensin axis inhibitors and beta-blockers. Methods: 347 patients with HF admissions and depressed LV ejection fraction (LVEF), fulfilling Framingham criteria at the VA Hospital from 2002 to 2004 were analyzed according to use of digoxin at discharge. Multi-variable Cox regression was used to determine the association of digoxin with future re-hospitalizations for HF and total mortality. Results: Overall, subjects were elderly (68 6 11), almost exclusively male, had depressed EF (23 6 10 %), and advanced HF (NYHA III and IV in 80%). Ischemic heart disease (64%), hypertension (79%), diabetes (47%) and chronic kidney disease (56%) were highly prevalent. 155 (45%) patients were on digoxin. Subjects on digoxin had lower LVEF, more prior HF hospitalizations, more atrial fibrillation but lower prevalence of hypertension. Covariate adjusted combined endpoint of HF hospitalization and total mortality (HR 1.03, 95% CI 0.78e1.35, p 5 0.852), and individual endpoints were not different in subjects on vs. not on digoxin (Table). Conclusions: Digoxin use was not associated with reduction in HF hospitalization or overall mortality in a cohort of patients on contemporary HF treatment including concomitant use of beta-blockers with ACE-inhibitors. Total Mortality and HF Hospitalization by Digoxin Use

Mortality HF Hospitalization Combined

Unadjusted HR (95% CI, p value)

Adjusted HR (95% CI, p value)

1.16 (0.90e1.49, p 5 0.258) 1.30 (0.96e1.76, p 5 0.096) 1.15 (0.85e1.55, p 5 0.371)

1.03 (0.78e1.35, p 5 0.852) 1.08 (0.77e1.50, p 5 0.663) 1.11 (0.81e1.53, p 5 0.521)