The previous use of digoxin does not worsen early outcome of acute coronary syndromes: an analysis of the ARIAM Registry

Abstract

The aim of the study was to determine the influence of the previous use of digoxin on the hospital mortality and complications of patients admitted because of acute coronary syndrome (ACS). We analyzed the data of patients included in the ARIAM-Andalucia Registry, which involves 49 hospitals in Andalucia, Spain, from 2007 to 2012. Patients on digoxin treatment prior to their admission because of ACS constituted the digoxin group (DG), and were compared with the group of patients not on digoxin. Logistic regression and propensity score matching were used to analyze the differences. We included 20,331 patients, of whom 244 (1.2%) were on digoxin. DG patients were older (73.1 vs 63.7 years old), more often women, and had more diabetes, hypertension, previous myocardial infarction, heart failure, stroke, atrial fibrillation, peripheral vascular disease, obstructive pulmonary disease or kidney disease. On univariate analysis, DG patients had significantly higher hospital mortality (13.5 vs 5.3% P < 0.001), and more cardiogenic shock, but less ventricular fibrillation, and no differences in atrioventricular block, stroke or reinfarction. After the multivariate analysis, DG had no significant influence on hospital prognosis [odds ratio (OR) 1.21, 95% confidence interval 0.79-1.86]. The analysis of a propensity-matched cohort of 464 patients (232 DG and 232 NoDG) did not find differences in hospital mortality (13.4 vs 13.4%) nor other complications. In our cohort of ACS patients, the previous treatment with digoxin was not associated with an increase in dysrhythmic complications nor was an independent predictor of mortality during hospitalization.

Safety and efficacy of digoxin: systematic review and meta-analysis of observational and controlled trial data

“…Study descriptors are summarised in table A in appendix 1. Of the 42 studies, 26 were retrospective or prospective cohorts,6 7 25 28 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 nine were post hoc analyses of randomised trials,20 21 60 61 62 63 64 65 66 and seven were randomised on the basis of digoxin 930 31 67 68 69 70 The length of follow-up (weighted average) was 3.7 (SD 2.4) years with a range of 0.25-8.2 years.…”

“…Forty one studies were suitable for meta-analysis of all cause mortality 67 8 9 20 21 25 26 30 31 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 These studies contributed to 75 separate analyses, with an overall combined total of 999 994 patients and 4 006 210 patient years of follow-up across four analysis subtypes (table 2). Figure 2 presents a summary of the individual meta-analyses performed.…”

“…Adjusted mortality data were available for 22 observational analyses (n=245 049) 721 26 41 42 43 44 45 47 50 53 55 56 57 58 59 62 63 65 66 Compared with control, digoxin was associated with an increased risk of death (risk ratio 1.61, 95% confidence interval 1.31 to 1.97, P<0.001; hazard ratio 1.17, 1.07 to 1.29, P=0.001; see fig C in appendix 3). In studies that enrolled only patients with heart failure and/or atrial fibrillation, the risk of death associated with digoxin use was of borderline significance (hazard ratio 1.16, 1.05 to 1.28; P=0.04).…”

“…Thirteen analyses (n=414 604) used a propensity matched cohort design 67 8 21 46 48 56 57 58 67 Compared with control, digoxin use was associated with a small increased risk of death in studies that reported risk ratio (1.18, 95% confidence interval 1.09 to 1.26; P<0.001). There was no significant association in studies that reported hazard ratios (1.07, 0.96 to 1.19; P=0.20; fig D in appendix 3).…”

Influence of the previous use of β-blockers on the early clinical course of acute coronary syndromes

“…Patients on b-blockers treatment prior to admission because of ACS constituted the b-blockers group (BB), and were compared with the group of patients not on b-blockers (NBB) at admission. Characteristics of the ARIAM-Andalucia Registry and the methods to obtain data have been previously described [14]. Data were analyzed retrospectively.…”