Digoxin and clinical outcomes in the Global Rheumatic Heart Disease Registry. Issue 5 (12th September 2018)

• Record Type: Journal Article
• Authors: Karthikeyan, Ganesan; Devasenapathy, Niveditha; Zühlke, Liesl; Engel, Mark Emmanuel; Rangarajan, Sumathy; Teo, Koon K; Mayosi, Bongani M; Yusuf, Salim
• Other Names: author non-byline.; Fadl Azza Abul author non-byline.; Sheta Sahar S author non-byline.; Haileamlak Abraham author non-byline.; Abdissa Senbeta G author non-byline.; Begna Dufera M author non-byline.; Daniel Wandimu author non-byline.; Desta Araya G author non-byline.; Goshu Dejuma Yadeta author non-byline.; Shasho Bekele A author non-byline.; Gitura Bernard author non-byline.; Ogendo Stephen author non-byline.; Kennedy Neil author non-byline.; Damasceno Albertino author non-byline.; Mocumbi Ana Olga author non-byline.; Hugo-hamman Christopher author non-byline.; Ojji Dike author non-byline.; Amusa Ganiyu A author non-byline.; Bode-thomas Fidelia author non-byline.; Yilgwan Christopher C author non-byline.; Ige Olukemi author non-byline.; Okeahialam Basil author non-byline.; Sani Mahmoud U author non-byline.; Ogah Okechukwu S author non-byline.; Olunuga Taiwo author non-byline.; Adeoye Abiodun M author non-byline.; Ogah Okechukwu author non-byline.; Mucumbitsi Joseph author non-byline.; Cupido Blanche author non-byline.; Mntla Phindile author non-byline.; Sutton Christopher author non-byline.; Misra Rajeev author non-byline.; Elsayed Ahmed author non-byline.; Ibrahim Ahmed S author non-byline.; M elhassan Huda H author non-byline.; Lwabi Peter author non-byline.; Mondo Charles author non-byline.; Okello Emmy author non-byline.; Al-kebsi Mohammed M author non-byline.; Musuku John author non-byline.;
• Is Part Of: Heart. Volume 105:Issue 5(2019)
• Page Start: 363
• Page End: 369
• Publication Date: 2018-09-12
• Subjects: valvular heart disease -- heart failure -- atrial fibrillation; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2018-313614
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: Digoxin is widely used in patients with rheumatic heart disease (RHD) despite a lack of data on its impact on clinical outcomes. We aimed to determine the association of digoxin use on clinical outcomes in patients with RHD. Methods: We performed a retrospective analysis of the association of digoxin use with mortality at 2 years in a large RHD registry. Secondary outcomes were recurrent heart failure (HF) and hospitalisation for any cause. We assessed associations using multivariable logistic regression in the entire cohort and in subgroups of patients with atrial fibrillation (AF) and HF. We also estimated average treatment effects from propensity-adjusted analyses using inverse probability treatment weighting. Results: Information on digoxin use at baseline was available for 98.7% (3298/3343) of patients. In the overall population, digoxin was significantly associated with mortality (OR 1.63, 95% CI 1.30 to 2.04, p<0.0001) and recurrent HF (OR 1.48, 95% CI 1.07 to 2.04, p=0.019). On propensity-weighted analyses, this effect was markedly attenuated (OR 1.05, 95% CI 1.01 to 1.09, p=0.005). Patients in sinus rhythm without HF had a higher propensity-adjusted odds of death with digoxin use (OR 1.06, 95% CI 1.01 to 1.12, p=0.015), but those with both AF and HF had lower mortality (OR 0.88, 95% CI 0.80 to 0.98, p=0.019). Conclusion: Digoxin use is associated with higher mortality in patients with RHD, but this is greatly attenuated on propensity adjustment, indicating the presence of substantial treatment bias. The adjusted estimates may therefore not be reliable, and large randomised trials are needed to determine the true effect of digoxin in patients with RHD.