Digoxin Initiation and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction

Am J Med. 2020 Oct;133(10):1187-1194. doi: 10.1016/j.amjmed.2020.02.040. Epub 2020 Apr 6.


Background: Digoxin reduces the risk of heart failure hospitalization in patients with heart failure with reduced ejection fraction. Less is known about this association in patients with heart failure with preserved ejection fraction (HFpEF), the examination of which was the objective of the current study.

Methods: In the Medicare-linked OPTIMIZE-HF registry, 7374 patients hospitalized for HF had ejection fraction ≥50% and were not receiving digoxin prior to admission. Of these, 5675 had a heart rate ≥50 beats per minute, an estimated glomerular filtration rate ≥30 mL/min/1.73 m2 or did not receive inpatient dialysis, and digoxin was initiated in 524 of these patients. Using propensity scores for digoxin initiation, calculated for each of the 5675 patients, we assembled a matched cohort of 513 pairs of patients initiated and not initiated on digoxin, balanced on 58 baseline characteristics (mean age, 80 years; 66% women; 8% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin initiation were estimated in the matched cohort.

Results: Among the 1026 matched patients with HFpEF, 30-day heart failure readmission occurred in 6% and 9% of patients initiated and not initiated on digoxin, respectively (HR 0.70; 95% CI, 0.45-1.10; P = .124). HRs (95% CIs) for 30-day all-cause readmission and all-cause mortality associated with digoxin initiation were 0.95 (0.73-1.23; P = .689) and 0.93 (0.55-1.56; P = .773), respectively. Digoxin initiation had no association with 6-year outcomes.

Conclusion: Digoxin initiation prior to hospital discharge was not associated with 30-day or 6-year outcomes in older hospitalized patients with HFpEF.

Keywords: Digoxin; Heart failure with preserved ejection fraction; Mortality; Readmission.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Aged, 80 and over
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Anti-Arrhythmia Agents / therapeutic use
  • Anticoagulants / therapeutic use
  • Atrial Fibrillation / drug therapy
  • Atrial Fibrillation / epidemiology
  • Cardiotonic Agents / therapeutic use*
  • Cause of Death
  • Digoxin / therapeutic use*
  • Female
  • Heart Failure / drug therapy*
  • Heart Failure / epidemiology
  • Heart Failure / physiopathology
  • Hospitalization
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Male
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Mortality*
  • Patient Readmission / statistics & numerical data*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Propensity Score
  • Proportional Hazards Models
  • Registries
  • Sodium Potassium Chloride Symporter Inhibitors / therapeutic use
  • Stroke Volume*
  • Warfarin / therapeutic use


  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Anti-Arrhythmia Agents
  • Anticoagulants
  • Cardiotonic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Mineralocorticoid Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Sodium Potassium Chloride Symporter Inhibitors
  • Warfarin
  • Digoxin