Previous trials have shown that
digoxin was beneficial in patients with
heart failure (HF). However, these studies were conducted before the incorporation of beta blockers as standard
therapy for patients with HF. The purpose of this study was to determine the effect of
digoxin in patients with HF on a contemporary regimen of
renin-
angiotensin inhibition and beta blockade. In 347 almost exclusively men, data pertaining to the index hospitalization and occurrence of all-cause mortality or readmission for HF were collected. Cox proportional hazard modeling was used. Patients on
digoxin therapy had a lower left ventricular (LV) ejection fraction (EF), higher prevalence of previous hospitalizations for HF and
atrial fibrillation, and lower prevalence of
hypertension. After adjustment for age, LVEF, history of HF hospitalizations, New York Heart Association class, presence of
chronic renal insufficiency, presence of
atrial fibrillation, and prescriptions for beta blockers and
angiotensin converting enzyme inhibitors or
angiotensin receptor blockers, HF hospitalizations (hazard ratio 1.08, 95% confidence interval [CI] 0.77 to 1.50, p = 0.66), total mortality (hazard ratio 1.03, 95% CI 0.78 to 1.35, p = 0.85), or the combined end point of HF hospitalization and total mortality (hazard ratio 1.11, 95% CI 0.81 to 1.53, p = 0.52) were not different in patients using
digoxin compared with those not using
digoxin. Clinical outcomes were not different in subgroups of patients with EF < or =25%, New York Heart Association class III or IV,
atrial fibrillation, heart rate < or =60 beats/min, or patients on beta-blocker
therapy. In conclusion,
digoxin use was not associated with a decrease in HF hospitalizations or overall mortality rates in a cohort of hospitalized patients with HF with
LV systolic dysfunction on contemporary background HF treatment including
angiotensin-converting enzyme inhibitors and beta blockers.