Digoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure
Autor: | Stefan D. Anker, Dirk J. van Veldhuisen, Gerasimos Filippatos, Gregg C. Fonarow, Prakash Deedwania, Robert C. Bourge, Richard M. Allman, Charity J. Morgan, Inmaculada Aban, Jerome L. Fleg, Ali Ahmed, Clyde W. Yancy, Thomas E. Love, Kanan Patel |
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Přispěvatelé: | Cardiovascular Centre (CVC) |
Rok vydání: | 2014 |
Předmět: |
CHRONIC KIDNEY-DISEASE
Male Aging Digoxin Cardiovascular Medical and Health Sciences law.invention Randomized controlled trial law 80 and over DIG TRIAL Aged 80 and over Ejection fraction Hazard ratio General Medicine Hospital readmission Patient Discharge INVESTIGATION GROUP TRIAL Heart Disease Treatment Outcome PRESERVED EJECTION FRACTION Cardiology Female medicine.drug medicine.medical_specialty Cardiotonic Agents CLINICAL EFFECTIVENESS Heart failure Medicare Patient Readmission Drug Administration Schedule Clinical Research General & Internal Medicine Internal medicine medicine Humans Decompensation Aged Heart Failure OLDER PATIENTS business.industry MORTALITY medicine.disease United States Confidence interval RENIN-ANGIOTENSIN INHIBITION CONVERTING ENZYME-INHIBITORS Case-Control Studies Chronic Disease Propensity score matching PROPENSITY-SCORE business Systolic Heart Failure Systolic |
Zdroj: | American Journal of Medicine, 127(1), 61-70. ELSEVIER SCIENCE INC The American journal of medicine, vol 127, iss 1 |
ISSN: | 0002-9343 |
DOI: | 10.1016/j.amjmed.2013.08.027 |
Popis: | 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 0.91; 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. (C) 2014 Elsevier Inc. All rights reserved. |
Databáze: | OpenAIRE |
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