Short Course Digoxin in Acute Heart Failure

Abstract

Background Despite many critical voices regarding its efficacy and safety, digoxin may still have a role in the management of heart failure. The objective of this study was to evaluate the efficacy and safety of a short course digoxin therapy started in the emergency department based on clinical outcome after 30 days post hospital discharge. Methods From Great Tunisian registry, acute decompensated heart failure (ADHF) patients from January 2016 to January 2018 were identified. Patients with incomplete data were excluded. Digoxin treated and non-treated patients were compared in a matched control study with respect to primary outcomes of all-cause mortality and HF readmission. Secondary outcomes included changes of cardiac output (CO) and left ventricular ejection fraction (LVEF) after 72 hours of hospital admission. 229 matched non-treated with a median age of 67.4±12.8. After 72 hours of ED admission, there was a larger increase of CO (17.8 % vs 14%; p=0.015) and LVEF (14.4% vs 3.5%; p=0.003) in digoxin group compared to control group. At 30-day post-hospital discharge 34 (10.2%) patients died and 72 (21.6%) patients were readmitted. Use of digoxin was associated with decreased risk of death and hospital readmission [odds ratio, 0.79 (95% CI, 0.71-0.89)]. In ADHF patients, treatment with digoxin was associated with a significant decrease risk of 30-day mortality and hospital readmission with an improvement of cardiac output and left ventricular ejection fraction.