Premium
Serum digoxin concentration and outcomes in women with heart failure: A bi‐directional effect and a possible effect modification by ejection fraction
Author(s) -
Ahmed Ali,
Aban Inmaculada B.,
Weaver Michael T.,
Aronow Wilbert S.,
Fleg Jerome L.
Publication year - 2006
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2005.10.002
Subject(s) - medicine , digoxin , ejection fraction , heart failure , odds ratio , confidence interval , digitalis , placebo , cardiology , pathology , alternative medicine
Background: The association between serum digoxin concentration (SDC) and outcomes in women with heart failure (HF) has not been well studied. Aims: To test the hypothesis that the effect of digoxin on outcomes in women with HF is bi‐directional and dependent on SDC, as in men, and is modified by ejection fraction (EF). Methods: We studied 1366 female participants of the Digitalis Investigation Group trial in whom data on SDC (ng/ml) were available. We calculated adjusted odds ratios (AOR) and Bonferroni‐adjusted 97.5% confidence intervals (CI) for various outcomes at a median follow up of 41 months, in all women and stratified by EF 35%. Results: Compared with placebo (26.9%), 40.3% with SDC≥1.2 (AOR=1.80; CI=1.14–2.86; p =0.004) and 26.6% with SDC 0.5–1.1 (AOR=1.05; CI=0.73–1.51; p =0.762) died. Respective rates for HF‐hospitalizations were: placebo (32.8%), SDC≥1.2 (38.0%) and SDC 0.5–1.1 (25.5%). For women with EF<35% ( N =677), SDC 0.5–1.1 lowered odds for HF‐hospitalizations (AOR=0.63; CI=0.39–1.00; p =0.026) without increasing odds for death (AOR=0.77; CI=0.47–1.26; p =0.233). In women with EF≥35% ( N =689), SDC 0.5–1.1 had a borderline association with death (AOR=1.58; CI=0.92–2.72; p =0.058) but not with HF‐hospitalization (AOR=0.95; CI=0.54–1.66; p =0.826). Conclusions: As in men, in women with HF, digoxin has a bi‐directional effect based on SDC, and the beneficial effects were significant only among women with EF<35%.