Digoxin and 30-Day All-Cause Readmission in Long-Term Care Residents Hospitalized for Heart Failure.
Helen M Sheriff, Manik R Thogaripally, Gurusher Panjrath and 13 others
PMID 28501416WHAT IT FOUND
In long-term care residents hospitalized for heart failure, a discharge digoxin prescription did not lower 30-day all-cause readmission compared with no digoxin.
It also did not lower heart failure readmission, mortality, or one-year outcomes.
Key findings
01In matched long-term care residents, 30-day all-cause readmission occurred in 21% of those receiving digoxin and 20% of those not receiving digoxin (hazard ratio 1.02; 95% confidence interval 0.63 to 1.66; P=0.935).
02Digoxin use was not associated with 30-day all-cause mortality (11% versus 13%; hazard ratio 0.90) or with the combined endpoint of mortality or readmission (hazard ratio 0.97).
03During one year after discharge, digoxin use had no association with all-cause or heart failure readmission, all-cause mortality, or the combined endpoint.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was small and observational, so it cannot prove that digoxin had no effect; unmeasured or residual confounding may remain. The sample came from fee-for-service Medicare beneficiaries in one state from 1999 to 2001, and only 20% received beta-blockers, so it may not apply to current long-term care residents. The researchers had no data on whether patients continued taking digoxin after discharge or changed treatment during follow-up. Because the primary result was null, the planned sensitivity analysis for hidden bias could not be performed. The subgroup with low ejection fraction showed signals that were not the primary analysis, so they should not be used to guide treatment decisions.
The easy way to misread this
Do not read the low ejection fraction subgroup result, including the pre-match hazard ratio of 6.51, as proof that digoxin harms or helps readmission in that group. The primary matched analysis was null, with a hazard ratio of 1.02 and P=0.935, and the subgroup finding was not the main endpoint.