• Òscar Miró, MojarroEnrique MartínEM0000-0001-9231-8398Emergency Department, Hospital Sant Pau I Santa Tecla, Tarragona, Catalonia, Spain., Gabrielle Huré, Pere Llorens, Víctor Gil, Aitor Alquézar-Arbé, Carlos Bibiano, Nayra Cabrera González, Marta Massó, Ivo Strebel, Begoña Espinosa, Silvia Mínguez Masó, Desiree Wussler, Samyut Shrestha, Pedro Lopez-Ayala, Javier Jacob, Javier Millán, Juan Antonio Andueza, Héctor Alonso, Silvia Larrondo Pàmies, CerdàJaume FarréJFEmergency Department, Hospital Sant Pau I Santa Tecla, Tarragona, Catalonia, Spain., Celia Planco Martínez, Pablo Herrero, Frank PeacockWWThe GREAT Network, Rome, Italy.Emergency Department, Baylor College of Medicine, Houston, TX, USA., Christian Mueller, and investigators of the ICA-SEMES, CRIB research group.
• Emergency Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain. omiro@clinic.cat.
• Intern Emerg Med. 2024 Aug 22.

AbstractDigoxin is commonly used to treat acute heart failure (AHF), especially in patients with concurrent atrial fibrillation (AF). Nonetheless, there is little consensus about in which patients digoxin should be given, the proper time for digoxin initiation, and whether digoxin initiation is associated with improved outcomes. We investigated factors related to digoxin initiation after an episode of AHF and whether patients receiving digoxin presented better short-term outcomes. We analyzed digoxin-naïve AHF patients from a Spanish and Swiss database, who were dichotomized into cohorts based on their receipt of digoxin treatment at discharge. The relationship between digoxin initiation and 23 additional patient covariates, including chronic treatment, was investigated, as well as its association with 90-day combined adverse events (defined as all-cause death or AHF hospitalization). Of 13,105 patients (10,600/2505 from the Spanish/Swiss cohorts, respectively), the median (interquartile range) age was 83 (74.87) years, and 51% were women. Of these, 484 (3.7%) received digoxin at discharge, which was associated with AF, female sex, left ventricular ejection fraction (LVEF) < 50%, and coming from the Spanish cohort. Parameters inversely associated with receiving digoxin at discharge included some chronic treatments, diabetes mellitus (DM), and chronic kidney disease (CKD). Digoxin initiation was not association with 90-day adverse events, adjusted hazard ratio (aHR) = 0.939 (0.769-1.146), but there was an interaction for CKD, aHR = 1.390 (0.831-2.325) vs. 0.854 (0.682-1.183), p = 0.039, and for cohort pertinence, with higher risk in the Swiss cohort; aHR = 1.405 (0.827-2.386) vs. 0.862 (0.689-1.077), p = 0.046. Digoxin initiation after an AHF episode was more frequent in the Spanish cohort and was associated with certain patient characteristics (AF, female sex, reduced LVEF, no DM, no CKD), but had no effect on 90-day outcomes.© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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