Introduction: The use of digitalis has been plagued by controversy since its initial use. Previous observations have shown that digoxin can be safely used in patients with chronic heart failure (HF), but concern remains about the effects of digoxin on mortality in patients with incident HF in the acute setting, especially in those with myocardial infarction. Hypothesis: We aimed to determine the relationship between digoxin use and outcomes in hospitalized patients with acute coronary syndromes (ACS) complicated by HF accounting for sex difference and prior heart diseases. Methods: We analyzed information on 88,774 patients presenting with acute HF (Killip class ≥2) in the International Survey of Acute Coronary Syndromes (ISACS)-Archives (NCT04008173) registry, 4,722 (18.7%) who received digoxin on hospital admission. Patients with pre-existing nonischemic congestive cardiomyopathy and without HF were excluded, leaving a final study population of 25,187 patients. The main outcome measure was all-cause 30-day mortality. Estimates were evaluated by inverse probability of treatment weighting models. Results: Women who received digoxin had a higher rate of death than women who did not receive it (33.8% vs. 29.2 %; relative risk [RR] ratio:1.24;95 % confidence interval [CI]: 1.12-1.37). Similar odds for mortality with digoxin were observed in men (28.5 % vs. 24.9 %; RR ratio 1.20; 95% CI:1.10-1.32). Comparable results were obtained in patients with no prior coronary heart disease (RR ratios:1.26; 95 % CI: 1.10 to 1.45 in women and RR:1.21; 95 % CI: 1.06 to 1.39 in men) and those in sinus rhythm at admission (RR ratios:1.34; 95% CI 1.15 to 1.54 in women and 1.26; 95% CI 1.10 to 1.45 in men). Conclusions: Digoxin therapy is associated with an increased risk of early death among women and men with ACS complicated by HF. This finding highlights the need for re-examination of digoxin use in the clinical setting of ACS

Concerns About the Use of Digoxin in Acute Coronary Syndromes / Edina Cenko, Maria Bergami, Jinsung Yoon, Mihaela van der Schaar, Sasko Kedev, Chris P Gale, Zorana Vasiljevic, Davor Milicic, Marija Zdravkovic, Gordana Krljanac, Lina Badimon, Olivia Manfrini, Raffaele Bugiardini. - In: CIRCULATION. - ISSN 0009-7322. - ELETTRONICO. - 144:(2021), pp. A12334-A12334. [10.1161/circ.144.suppl_1.12334]

Concerns About the Use of Digoxin in Acute Coronary Syndromes

Edina Cenko;Maria Bergami;Olivia Manfrini;Raffaele Bugiardini
2021

Abstract

Introduction: The use of digitalis has been plagued by controversy since its initial use. Previous observations have shown that digoxin can be safely used in patients with chronic heart failure (HF), but concern remains about the effects of digoxin on mortality in patients with incident HF in the acute setting, especially in those with myocardial infarction. Hypothesis: We aimed to determine the relationship between digoxin use and outcomes in hospitalized patients with acute coronary syndromes (ACS) complicated by HF accounting for sex difference and prior heart diseases. Methods: We analyzed information on 88,774 patients presenting with acute HF (Killip class ≥2) in the International Survey of Acute Coronary Syndromes (ISACS)-Archives (NCT04008173) registry, 4,722 (18.7%) who received digoxin on hospital admission. Patients with pre-existing nonischemic congestive cardiomyopathy and without HF were excluded, leaving a final study population of 25,187 patients. The main outcome measure was all-cause 30-day mortality. Estimates were evaluated by inverse probability of treatment weighting models. Results: Women who received digoxin had a higher rate of death than women who did not receive it (33.8% vs. 29.2 %; relative risk [RR] ratio:1.24;95 % confidence interval [CI]: 1.12-1.37). Similar odds for mortality with digoxin were observed in men (28.5 % vs. 24.9 %; RR ratio 1.20; 95% CI:1.10-1.32). Comparable results were obtained in patients with no prior coronary heart disease (RR ratios:1.26; 95 % CI: 1.10 to 1.45 in women and RR:1.21; 95 % CI: 1.06 to 1.39 in men) and those in sinus rhythm at admission (RR ratios:1.34; 95% CI 1.15 to 1.54 in women and 1.26; 95% CI 1.10 to 1.45 in men). Conclusions: Digoxin therapy is associated with an increased risk of early death among women and men with ACS complicated by HF. This finding highlights the need for re-examination of digoxin use in the clinical setting of ACS
2021
Concerns About the Use of Digoxin in Acute Coronary Syndromes / Edina Cenko, Maria Bergami, Jinsung Yoon, Mihaela van der Schaar, Sasko Kedev, Chris P Gale, Zorana Vasiljevic, Davor Milicic, Marija Zdravkovic, Gordana Krljanac, Lina Badimon, Olivia Manfrini, Raffaele Bugiardini. - In: CIRCULATION. - ISSN 0009-7322. - ELETTRONICO. - 144:(2021), pp. A12334-A12334. [10.1161/circ.144.suppl_1.12334]
Edina Cenko, Maria Bergami, Jinsung Yoon, Mihaela van der Schaar, Sasko Kedev, Chris P Gale, Zorana Vasiljevic, Davor Milicic, Marija Zdravkovic, Gordana Krljanac, Lina Badimon, Olivia Manfrini, Raffaele Bugiardini
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/853114
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