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| |  Digoxin Decreases Symptoms and Hospitalisations in Patients With Diastolic Heart Failure: Presented at HFSA By Jill Stein TORONTO -- September 24, 2008 -- Digoxin reduces symptoms and hospitalisation rates in patients with diastolic heart failure, according to data reported here at the Heart Failure Society of America (HFSA) 12th Annual Scientific Meeting. In their study, a subanalysis of the Digitalis Investigation Group (DIG) trial presented on September 23, Philippe Meyer, MD, Montreal Heart Institute, Montreal, Quebec, and colleagues used propensity score matching to assemble a cohort of 916 pairs of patients with systolic and diastolic heart failure who were matched on all measured baseline covariates. Few interventions to decrease hospitalisations for heart failure have been examined in patients with diastolic heart failure even though these patients account for about half of all cases of heart failure, according to the investigators. The researchers defined systolic heart failure as a left ventricular ejection fraction <=45% and diastolic heart failure as left ventricular ejection fraction >45%. Results showed that digoxin treatment significantly decreased hospitalisations for heart failure in patients with systolic heart failure in the main DIG trial but did not have the same effect on diastolic heart failure in the ancillary trial. This disparity in the effect of digoxin has been ascribed to the smaller sample size of the ancillary trial and potential baseline differences between patients with systolic heart failure and those with diastolic heart failure, they added. However, this possibility has never been systematically examined and may have been a factor in the potential underuse of digoxin in diastolic heart failure. In the present analysis, the researchers analysed the effect of digoxin on the combined endpoint of heart failure hospitalisation alone, both at 2 years and after a median 3.2 years of follow-up. Results showed that heart failure-related hospitalisation or death occurred in 28% and 32% of patients with systolic heart failure (hazard ratio [HR] when digoxin was compared with placebo = 0.85, P = .188), and in 20% and 25% of patients with diastolic heart failure treated with digoxin and placebo, respectively (HR = 0.79, P = .085). At 2 years, HR for this combined endpoint was similar for systolic heart failure (HR 0.72, P = .022) and diastolic heart failure (HR 0.69, P = .025). Digoxin also decreased hospitalisations for heart failure in both systolic heart failure (HR = 0.73, P = .033) and diastolic heart failure patients (HR = 0.64, P = .010). Based on these findings, the authors recommended that digoxin be prescribed in patients with diastolic heart failure with the goal of decreasing heart failure symptoms and hospitalisations.
[Presentation title: Digoxin in Chronic Systolic and Diastolic Heart Failure: Similar Effects? Abstract 252]
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