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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EA post hoc subanalysis of the Digitalis Investigation Group [DIG] trial found that digoxin reduces all-cause hospital admission at 30 days in older ambulatory patients with chronic systolic heart failure (HF) [Bourge RC. \u003Cem\u003EAm J Med\u003C\/em\u003E 2013]. Reduction in hospital readmissions is of particular interest in the United States due to related financial penalties levied by the Center for Medicare and Medicaid Services from October 2012 for older patients with HF.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EA post hoc subanalysis of the Digitalis Investigation Group trial found that digoxin reduces all-cause hospital admission at 30 days in older ambulatory patients with chronic systolic heart failure (HF) [Bourge RC. \u003Cem\u003EAm J Med\u003C\/em\u003E 2013]. Reduction in hospital readmissions is of particular interest in the United States due to related financial penalties levied by the Center for Medicare and Medicaid Services (CMS) from October 2012 for older patients with HF.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe objective of the post hoc analysis by Ali Ahmed, MD, MPH, University of Alabama, Birmingham, Alabama, USA, and colleagues, was to examine the effect of digoxin on 30-day all-cause hospital admission in a subgroup of older, potentially Medicare-eligible, adults with HF and reduced ejection fraction from the main DIG trial which randomized 6800 ambulatory patients with chronic HF to either digoxin or placebo on a background of standard therapy from 1991 through 1993 [DIG Investigators. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1997].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe presented analysis included a subset of 3405 patients aged \u226565 years with chronic HF (ejection fraction \u226445%) in normal sinus rhythm from the United States and Canada. They had a mean age of 72 (\u00b15) years, 25% were women, 76% had a primary etiology of ischemic heart failure, 61% had chronic kidney disease, and 11% were nonwhite. Angiotensin-converting enzyme inhibitors were used at baseline in 94% and diuretics were used in 82%. The proportion on \u03b2-blockers was not collected.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the subgroup of interest, 1712 were randomized to digoxin and 1693 to placebo. Overall, baseline characteristics between groups were similar except for a slightly lower body mass index among those assigned to digoxin (p=0.04).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the 30 days after randomization, the all-cause hospital admission rate was significantly lower in the digoxin- versus placebo-treated group (5.4% vs 8.1%, respectively; HR, 0.66; 95% CI, 0.51 to 0.86; p=0.002; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Over the same time period, digoxin reduced both the absolute (\u22122.7%) and relative (\u221234%) risks of all-cause hospital admission.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/2\/22\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u002230-Day All-Cause Hospital Admissions With Digoxin Versus Placebo\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1179246798\u0022 data-figure-caption=\u002230-Day All-Cause Hospital Admissions With Digoxin Versus Placebo\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/2\/22\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/2\/22\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/2\/22\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13138\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003E30-Day All-Cause Hospital Admissions With Digoxin Versus Placebo\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from A Ahmed, MD, MPH.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EThe reduction in all-cause hospital admissions with digoxin persisted through 60 days (HR, 0.76; 95% CI, 0.63 to 0.91; p=0.003) and 90 days (HR, 0.75; 95% CI, 0.63 to 0.88; p\u0026lt;0.001) post randomization. This suggests that the early benefit of digoxin was not achieved at the cost of harm at a later time.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn the 30 days following randomization, digoxin significantly reduced the risk of hospital admission due to cardiovascular causes by 47% (HR, 0.53; 95% CI, 0.38 to 0.72; p\u0026lt;0.001) and due to worsening HF by 60% (HR, 0.40; 95% CI, 0.26 to 0.62; p\u0026lt;0.001). Differences between 30-day mortality outcomes for all-cause and cardiovascular mortality were not significant between the digoxin and placebo groups. A favorable trend toward less frequent progression of HF (HR, 0.22; 95% CI, 0.05 to 1.04; p=0.056) was observed with digoxin.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ESince these results were derived from post hoc subgroup analyses, the findings should be considered hypothesis-generating that require confirmation in prospective studies. Clinicians should be cautious about generalizing these results to patients in clinical practice, in part because the study was conducted in the early 1990s when current background therapies were either not standard-of-care (eg, \u03b2-blockers, spironolactone) or unavailable (eg, angiotensin receptor blockers).\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EIf these findings can be replicated in current older HF patients on guideline recommended background therapy, digoxin may be a low-cost option to reduce 30-day all-cause readmissions and avoid penalties imposed by CMS.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/2\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzo1np\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo1np\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}