Evidence map›Paper›PMID 31370952›Full record

ArticleJournal of the American College of Cardiology2019

Digoxin Discontinuation and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction.

Awais Malik, Ravi Masson, Steven Singh, Wen-Chih Wu, Milton Packer, Bertram Pitt, Finn Waagstein, Charity J Morgan, Richard M Allman, Gregg C Fonarow and 1 more

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 2 pooled it
5.3field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 54 citations in OpenAlex.

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  10. The NaFrontiers in endocrinology · 2023
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  18. Modified SAMe-TTHerz · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 8 institutions in 2 countries.

Awais MalikVeterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Ravi MassonVeterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Steven SinghVeterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Wen-Chih WuVeterans Affairs Medical Center, Providence, Rhode Island; Brown University, Providence, Rhode Island.
Milton PackerBaylor University Medical Center, Dallas, Texas.
Bertram PittUniversity of Michigan, Ann Arbor, Michigan.
Finn WaagsteinUniversity of Gothenburg, Gothenburg, Sweden.
Charity J MorganVeterans Affairs Medical Center, Washington, DC; University of Alabama at Birmingham, Birmingham, Alabama.
Richard M AllmanUniversity of Alabama at Birmingham, Birmingham, Alabama; George Washington University, Washington, DC.
Gregg C FonarowUniversity of California, Los Angeles, Los Angeles, California.
Ali AhmedVeterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC. Electronic address: ali.ahmed@va.gov.
Georgetown University · USBaylor University Medical Center · USGeorge Washington University · USProvidence College · USUniversity of California, Los Angeles · USUniversity of Gothenburg · SEUniversity of Michigan · USVeterans Health Administration · US

Funding

Heart failure, chronic kidney disease, and renin-angiotensin system inhibitionR01HL085561 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2006 to 2009
$1.5M
Neurohormonal Blockade and Outcomes in Diastolic Heart FailureR01HL097047 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2009 to 2010
$915k
NHLBI NIH HHS R01 HL085561NHLBI NIH HHS R01 HL097047
6 · The paper itself

Abstract

backgroundThe deleterious effects of discontinuation of digoxin on outcomes in ambulatory patients with chronic heart failure (HF) with reduced ejection fraction (HFrEF) receiving angiotensin-converting enzyme inhibitors are well-documented.

objectivesThe authors sought to determine the relationship between digoxin discontinuation and outcomes in hospitalized patients with HFrEF receiving more contemporary guideline-directed medical therapies including beta-blockers and mineralocorticoid receptor antagonists.

methodsOf the 11,900 hospitalized patients with HFrEF (EF ≤45%) in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry, 3,499 received pre-admission digoxin, which was discontinued in 721 patients. Using propensity scores for digoxin discontinuation, estimated for each of the 3,499 patients, a matched cohort of 698 pairs of patients, balanced on 50 baseline characteristics (mean age 76 years; mean EF 28%; 41% women; 13% African American; 65% on beta-blockers) was assembled.

resultsFour-year post-discharge, digoxin discontinuation was associated with significantly higher risks of HF readmission (hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 1.05 to 1.39; p = 0.007), all-cause readmission (HR: 1.16; 95% CI: 1.04 to 1.31; p = 0.010), and the combined endpoint of HF readmission or all-cause mortality (HR: 1.20; 95% CI: 1.07 to 1.34; p = 0.002), but not all-cause mortality (HR: 1.09; 95% CI: 0.97 to 1.24; p = 0.163). Discontinuation of digoxin was associated with a significantly higher risk of all 4 outcomes at 6 months and 1 year post-discharge. At 30 days, digoxin discontinuation was associated with higher risks of all-cause mortality (HR: 1.80; 95% CI: 1.26 to 2.57; p = 0.001) and the combined endpoint (HR: 1.36; 95% CI: 1.09 to 1.71; p = 0.007), but not of HF readmission (HR: 1.19; 95% CI: 0.90 to 1.59; p = 0.226) or all-cause readmission (HR: 1.03; 95% CI: 0.84 to 1.26; p = 0.778).

conclusionsAmong hospitalized older patients with HFrEF on more contemporary guideline-directed medical therapies, discontinuation of pre-admission digoxin therapy was associated with poor outcomes.

Indexed as

RegistriesAgedCardiotonic AgentsCause of DeathDigoxinFemaleHeart FailureHumansMaleOutpatientsPatient ReadmissionPropensity ScoreRetrospective StudiesRisk FactorsStroke VolumeSurvival RateCardiotonic AgentsDigoxindigoxin discontinuationheart failuremortalityreadmissionreduced ejection fraction

Identifiers

PMID31370952
PMCPMC10465068
OpenAlexW2965239074

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.