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
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