American Journal of Cardiology
Volume 102, Issue 12 , Pages 1681-1686 , 15 December 2008

Digoxin and Reduction of Heart Failure Hospitalization in Chronic Systolic and Diastolic Heart Failure

  • Philippe Meyer, MD

      Affiliations

    • Montreal Heart Institute, Montreal, Quebec, Canada
    • ,
  • Michel White, MD

      Affiliations

    • Montreal Heart Institute, Montreal, Quebec, Canada
    • ,
  • Marjan Mujib, MBBS

      Affiliations

    • University of Alabama at Birmingham, Birmingham, Alabama
    • ,
  • Anna Nozza, MSc

      Affiliations

    • Montreal Heart Institute, Montreal, Quebec, Canada
    • ,
  • Thomas E. Love, PhD

      Affiliations

    • Case Western Reserve University, Cleveland, Ohio
    • ,
  • Inmaculada Aban, PhD

      Affiliations

    • University of Alabama at Birmingham, Birmingham, Alabama
    • ,
  • James B. Young, MD

      Affiliations

    • Cleveland Clinic Foundation, Cleveland, Ohio
    • ,
  • William H. Wehrmacher, MD

      Affiliations

    • Loyola University, Chicago, Illinois
    • ,
  • Ali Ahmed, MD, MPH

      Affiliations

    • University of Alabama at Birmingham, Birmingham, Alabama
    • VA Medical Center, Birmingham, Alabama
    • Corresponding Author InformationCorresponding author: Tel: 205-934-9632; fax: 205-975-7099

Received 6 April 2008 ,Revised 20 May 2008 ,Accepted 20 May 2008.

References 

  1. Hunt SA. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005;46(suppl):e1–e82
  2. Ahmed A, Perry GJ, Fleg JL, Love TE, Goff DC, Kitzman DW. Outcomes in ambulatory chronic systolic and diastolic heart failure: a propensity score analysis. Am Heart J. 2006;152:956–966
  3. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355:260–269
  4. Ahmed A, Allman RM, Fonarow GC, Love TE, Zannad F, Dell'italia LJ, et al. Incident heart failure hospitalization and subsequent mortality in chronic heart failure: a propensity-matched study. J Card Fail. 2008;14:211–218
  5. The Digitalis Investigation Group Investigators. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525–533
  6. Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB, Kitzman DW, et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation. 2006;114:397–403
  7. Ahmed A, Young JB, Gheorghiade M. The underuse of digoxin in heart failure, and approaches to appropriate use. CMAJ. 2007;176:641–643
  8. Gheorghiade M, Zannad F, Sopko G, Klein L, Pina IL, Konstam MA, et al. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112:3958–3968
  9. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003;362:777–781
  10. The Digitalis Investigation Group InvestigatorsDigitalis Investigation Group. Protocol: Trial to Evaluate the Effect of Digitalis on Mortality in Heart Failure. Bethesda, MD: National Heart, Lung, and Blood Institute; 1991;
  11. Ahmed A, Rich MW, Love TE, Lloyd-Jones DM, Aban IB, Colucci WS, et al. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J. 2006;27:178–186
  12. Collins JF, Howell CL, Horney RA. Determination of vital status at the end of the DIG trial. Control Clin Trials. 2003;24:726–730
  13. Ahmed A, Husain A, Love TE, Gambassi G, Dell'Italia LJ, Francis GS, et al. Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J. 2006;27:1431–1439
  14. Levesque R. Macros. In: SPSS Programming and Data Management. 2nd Ed.. Chicago: SPSS; 2005;A Guide for SPSS and SAS Users http://www.spsstools.net/spss_programming.htm
  15. D'Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265–2281
  16. Normand ST, Landrum MB, Guadagnoli E, Ayanian JZ, Ryan TJ, Cleary PD, et al. Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores. J Clin Epidemiol. 2001;54:387–398
  17. Rothwell PM. Treating individuals 2 (Subgroup analysis in randomised controlled trials: importance, indications, and interpretation). Lancet. 2005;365:176–186
  18. Rathore SS, Curtis JP, Wang Y, Bristow MR, Krumholz HM. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA. 2003;289:871–878
  19. Cleland JGF, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J PEPCHFI. The Perindopril in Elderly People with Chronic Heart Failure (PEP-CHF) study. Eur Heart J. 2006;27:2338–2345
  20. Carson P, Massie BM, McKelvie R, McMurray J, Komajda M, Zile M, et al. The irbesartan in heart failure with preserved systolic function (I-PRESERVE) trial: rationale and design. J Card Fail. 2005;11:576–585
  21. TOPCAT Study Investigators. Treatment of preserved cardiac function heart failure with an aldosterone antagonist. http://www.topcatstudy.com/Accessed March 17, 2008.
  22. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol. 2006;47:76–84

 Dr. Ahmed is supported by the National Institutes of Health (Bethesda, Maryland) through Grants 5-R01-HL085561-02 and P50-HL077100 from the National Heart, Lung, and Blood Institute (Bethesda, Maryland) and a generous gift from Ms. Jean B. Morris of Birmingham, Alabama.

PII: S0002-9149(08)01391-X

doi: 10.1016/j.amjcard.2008.05.068

American Journal of Cardiology
Volume 102, Issue 12 , Pages 1681-1686 , 15 December 2008

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