Digoxin for HF Fell Sharply in a Decade, Became More Selective

WASHINGTON, DC — Prescriptions for digoxin to patients discharged with reduced ejection-fraction (EF) heart failure fell by two-thirds over the 10 years ending in 2014, independent of age, sex, and history of atrial fibrillation (AF), in a look at about 250,000 patients in the Get With the Guidelines–Heart Failure (GWTG-HF) registry^[1]. Use of digoxin in preserved-EF heart failure was much less common but fell over the 10 years to a similar degree.

Throughout the decade, digoxin use was significantly associated with use of an implantable defibrillator (ICD) or pacemaker, lower ejection fraction, AF, chronic obstructive pulmonary disease, diabetes, and normal renal function, says a report published February 10, 2016 in JACC: Heart Failure. Digoxin was less likely to be prescribed to patients who were older, smoked, or had renal dysfunction, hypertension, ischemic heart disease, or anemia.

"These findings suggest cautious use of digoxin, with avoidance of digoxin in patient populations more susceptible to digoxin toxicity and using digoxin in patient populations that may potentially benefit the most," write the authors, led by Dr Nish Patel (University of Miami Miller School of Medicine, FL).

Digoxin's heyday in heart failure preceded the advent of beta-blockers as a cornerstone of therapy. Although it lately has both proponents and detractors, the older drug's benefit/risk profile in that setting has been challenged in studies in recent years.

At the 398 hospitals represented in the GWTG-HF analysis, digoxin prescriptions for reduced-EF heart failure fell from 33.1% of patients discharged in 2005 to 10.7% in 2014 (P<0.0001). The corresponding drop for patients with preserved-EF heart failure was from 16.0% to 5.7% (P<0.0001).

Appropriate randomized trials are needed to determine whether there may a benefit to adding digoxin to contemporary guidelines-based therapy, the authors point out. They might also show whether the drop-off in use "is appropriate and enhancing patient safety or whether it may be depriving patients with [reduced-EF heart failure] of an important medication to reduce HF hospitalizations and improve quality of life."

Patel reported no relevant financial relationships. Disclosures for the coauthors are listed in the article.

Cite this: Digoxin for Heart Failure Fell Sharply in a Decade, May Be Given More Selectively - Medscape - Feb 12, 2016.

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