Digoxin use linked to higher risk of death for patients with newly diagnosed heart failure

Digoxin, commonly used to treat heart conditions, was associated with a 72% higher rate of death among adults with newly diagnosed heart failure, according to a Kaiser Permanente study in the September issue of Circulation: Cardiovascular Quality and Outcomes.

Researchers evaluated the effectiveness and safety of digoxin in a contemporary cohort of 2,891 patients with incident systolic heart failure who had no prior digoxin use between 2006 and 2008 within Kaiser Permanente Northern California. They used multivariable extended Cox regression to examine the association between new digoxin use and risks of death and heart failure hospitalization, controlling for medical history, laboratory results, medications, heart failure disease severity, and the propensity for digoxin use. 

There were 801 deaths, and of these, 737were off digoxin and 64 were taking digoxin. After adjustment for potential confounders, digoxin use was associated with a 72% higher relative rate of death. There were 1,723 hospitalizations for heart failure overall (1,596 off digoxin, 127 on digoxin). However, after adjustment for potential confounders, digoxin use was not significantly associated with hospitalization for heart failure.

“Our community-based study population is more likely to represent patients with systolic heart failure in the modern era with regard to pathogenesis and treatment patterns,” Alan S Go, MD, senior author of the study and research scientist at the Kaiser Permanente Division of Research said. “Therefore, our results may more accurately represent the outcomes expected with digoxin for patients with systolic heart failure in typical present-day practices. As with all medication, treatment, or therapy plans, care decisions should always be made by physicians and their patients working together, with the patient's particular care needs and goals in mind.”