Old drug, new era: digoxin use and mortality under quadruple heart failure therapy
I T Colluoglu, T Kapansahin, H Aksu, V Erdinc, B Oksuzoglu, D Tosun, B Celik, A Bozkurt, K Kilic, K Korkmaz, K Oz, O Cakmak, A Yusufoglu, O Onalan, Y AkinAbstract
Background
There has been no scientific evidence concerning the impact of digoxin use combined with contemporary heart failure (HF) therapy, including beta blockers, renin-angiotensin-system inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors, on mortality in patients with HF.
Purpose
We aimed to evaluate the digoxin effect on 1-year all-cause mortality in HF patients receiving quadruple therapy.
Methods
We retrospectively included 236 patients with HF receiving quadruple therapy between January 1, 2022, and October 30, 2024. We divided the study population into two groups based on digoxin use. Binary logistic regression analysis was performed to identify independent predictors for 1- year all-cause mortality. Model included age, sex, atrial fibrillation, chronic kidney disease, LVEF, digoxin usage. The primary outcome was defined as 1-year all-cause mortality.
Results
Heart failure patients receiving quadruple therapy who were treated with digoxin demonstrated a higher prevalence of chronic kidney disease (56.3% vs. 27.1%), as well as lower LVEF (36% [28%–45%] vs. 40% [35%–50%]) and lower eGFR (54.50 ml/min/1.73m2 [45.25–65.25] vs. 66.00 ml/min/1.73m2 [49.75–88.25]) compared to those not treated with digoxin. Among patients receiving digoxin, the median digoxin level was 0.88 (0.65-1.19) ng/ml (Table 1). Mortality rate was significantly observed to be higher in patients with digoxin than those without digoxin (37.5% vs. 3.2%). Digoxin use was identified as an independent predictor of 1-year all-cause mortality (OR:20.786, 95%CI [6.793-63.609]) (Table 2).
Conclusion
In patients with HF under quadruple therapy, digoxin use was associated with a higher risk for all-cause mortality. This association may be partially explained by treatment timing, as digoxin is frequently prescribed later in the disease course, often in patients with more advanced HF.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.