676 JACC March 21, 2017 Volume 69, Issue 11
Heart Failure and Cardiomyopathies PREVALENT DIGOXIN USE IS NOT ASSOCIATED WITH INCREASED RISK OF DEATH OR HOSPITALIZATION IN AMBULATORY HEART FAILURE PATIENTS WITH A REDUCED EJECTION FRACTION 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 Authors: Andrew P. Ambrosy, Ankeet Bhatt, Amanda Stebbins, Lisa Wruck, Stephen Greene, Marat Fudim, William Kraus, Christopher O’Connor, Ileana Pina, David Whellan, Robert Mentz, Duke University Medical Center, Durham, NC, USA, Duke Clinical Research Institute, Durham, NC, USA 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 HFACTION 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.