scholarly journals Digoxin and association with mortality in patients discharged from hospital with atrial fibrillation, with or without heart failure

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Mpotis ◽  
A Kartas ◽  
A Samaras ◽  
E Akrivos ◽  
E Vrana ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Propensity Scores ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Event Analysis ◽  
Risk Of Death ◽  
Funding Sources ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf MISOAC- AF study group BACKGROUND Digoxin is widely used in atrial fibrillation (AF) and heart failure (AF). However, established evidence is conflicting regarding its association with clinical outcomes. AIM To investigate the relation between digoxin and adverse outcomes in patients with AF, with or without HF, in a contemporary AF cohort. METHODS We performed a retrospective analysis of data from 698 patients, originating from the MISOAC- AF (Motivational Interviewing to Support Oral AntiCoagulation Adherence in patients with non-valvular Atrial Fibrillation) trial, and followed over a median of 2.5 years. HF was denoted at baseline. The primary outcome was all-cause mortality and the secondary outcome was all-cause hospitalization, in a time-to-event analysis. Propensity scores were used to derive matched populations, balanced on key baseline covariates. To limit potential confounding, we also implemented inverse probability of treatment weighting (IPTW) analysis. RESULTS Among patients with HF, 10.5% (n = 39) were administered digoxin at baseline, whereas 89.5% (n = 331) were not. Digoxin administration was not associated with an increased risk of death (hazard ratio (HR) in the digoxin group, 1.21; 95% Confidence Interval (CI), 0.69 to 2.13, p = 0.5) or hospitalization of any cause (HR 1.15; 95% CI, 0.67 to 1.96; p = 0.6). Among patients without HF, 3.5% (n = 11) were administered digoxin, with neutral effects on all-cause mortality (HR: 3.25; 95% CI, 0.98 to 10.70), p = 0.06) and all-cause hospitalization (HR, 1.15; 95% CI, 0.67 to 1.96, p = 0.60). Consistent qualitatively results were observed using IPTW. CONCLUSIONS Among patients with AF, digoxin administration was not associated with an increased risk of death and hospitalization of any cause, irrespective of HF status. Abstract Figure.

Abstract 12936: Impact of Mitral Regurgitation on Heart Failure Hospitalization and Mortality in Older Age Adults With a Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ginger Y Jiang ◽  
Warren J Manning ◽  
Lawrence Markson ◽  
A. R Garan ◽  
Marwa A Sabe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
P Value ◽  
Preserved Ejection Fraction ◽  
Risk Of Death ◽  
Increased Risk ◽  
All Cause Mortality

Background: The effect of mitral regurgitation (MR) severity on heart failure (HF) hospitalization and mortality in individuals with a preserved ejection fraction (LVEF) and no prior HF history is uncertain. Methods: Transthoracic echocardiogram (TTE) reports from patients with an LVEF > 50% at our institution were linked to complete Medicare inpatient claims, 2003-2017. Patients with HF hospitalization within the 12 months prior to TTE were excluded. We evaluated the relationship of baseline MR severity and time to the composite of all-cause mortality or HF hospitalization using the Kaplan-Meier technique. Secondary outcomes included the individual components of all-cause mortality and HF hospitalization, adjusting for the competing risk of death with Fine-Gray methods. Results: A total of 18,315 individuals met inclusion criteria (77.6 ±7.7 years, 54.3% female). Over a median follow-up time of 6.5 (IQR 3.0 to 10.2) years, the primary endpoint occurred in 7566 individuals (50.6%) of whom 6,927 (37.8%) died and 1703 (13.9%) were admitted for HF at a median of 1.4 (IQR 0.2 to 4.3) years and 1.6 (IQR 0.2 to 4.3) years respectively ( Figure ). After multivariable adjustment, MR severity was not associated with the primary or secondary outcome at 1-, 3-, 5-, or 10-years after TTE (p > 0.05 for all). Mitral valve prolapse (MVP) was associated with decreased risk of the primary outcome at 1-year and 3-years (interaction p-value = 0.04 for both). Jet eccentricity did not impact the observed relationship (interaction p-value > 0.05). Conclusions: In this large, single institution echocardiographic study of individuals with preserved ejection fraction and no prior history of HF, MR severity was not associated with an increased risk of all-cause mortality or HF hospitalization. Presence of MVP was associated with decreased risk of the primary outcome with increasing MR severity.

scholarly journals Cerebral microbleeds and risk of adverse outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Corica ◽  
G.F Romiti ◽  
V Raparelli ◽  
R Cangemi ◽  
S Basili ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
Random Effect ◽  
Adverse Outcomes ◽  
Cerebral Microbleeds ◽  
Funding Sources ◽  
Conflicting Evidence ◽  
Pooled Prevalence ◽  
Increased Risk

Abstract Background Long-term anticoagulation in patients with atrial fibrillation (AF) imposes a careful balance between the thromboembolic and hemorrhagic risks. An association between cerebral microbleeds (CMBs) and an increased risk of intracranial hemorrhage (ICH) has already been described; however, conflicting evidence exist on the association with ischemic stroke (IS). Although CMBs are often observed in AF patients, the actual prevalence and the magnitude of the risk of adverse events in patients with CMBs is unclear. Purpose We aimed to estimate the pooled prevalence of CMBs in patients with AF through a systematic review and meta-analysis of the literature. Additionally, we evaluated the risk of ICH and IS according to the presence and burden of CMBs. Methods We perform a systematic search on PubMed and EMBASE from inception to 6th March 2021. We included all studies reporting the prevalence of CMBs, the incidence of ICH and/or IS in AF by presence of CMBs. Pooled prevalence and odds ratios (OR), along with their 95% Confidence Intervals (CI), were computed using random-effect models; we also calculated 95% Prediction Intervals (PI) for each outcome investigated. Additionally, we performed subgroup analyses according to the number and localization of CMBs. Results We retrieved 562 records from the literature search, and 17 studies were finally included. Pooled prevalence of CMBs in AF population was 28.3% (95% CI: 23.8%-33.4%; 95% PI: 12.2%-52.9%, Figure 1). Individuals with CMBs showed a higher risk of both ICH (OR: 3.04, 95% CI: 1.83–5.06) and IS (OR: 1.78, 95% CI: 1.26–2.49). Moreover, patients with more than 5 CMBs, as well as patients with both lobar and mixed CMBs, showed a higher risk of ICH. Conclusions CMBs were found in 28.3% of AF patients, with 95% PIs indicating a potentially higher prevalence. Moreover, CMBs were associated with an increased risk of both ICH and IS, with the effect potentially modulated by their number and localization. CMBs may represent an important and often overlooked risk factor for adverse outcomes in patients with AF. FUNDunding Acknowledgement Type of funding sources: None. Prevalence of CMBs in patients with AF

Abstract P369: Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Elderly Patients With Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Aniqa Alam ◽  
Nemin Chen ◽  
Pamela L Lutsey ◽  
Richard MacLehose ◽  
J'Neka Claxton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Rate Control ◽  
Treatment Effectiveness ◽  
Adverse Outcomes ◽  
Pharmacy Claims ◽  
Increased Risk ◽  
The Impact

Background: Polypharmacy is highly prevalent in elderly individuals with chronic conditions, including atrial fibrillation (AF). The impact of polypharmacy on adverse outcomes and on treatment effectiveness in elderly AF patients remains unaddressed. Methods: We studied 338,810 AF patients ≥75 years of age with 1,761,660 active prescriptions [mean (SD), 5.1 (3.8) per patient] enrolled in the MarketScan Medicare Supplemental database in 2007-2015. Polypharmacy was defined as ≥5 active prescriptions at AF diagnosis based on outpatient pharmacy claims. AF treatments (oral anticoagulation, rhythm and rate control) and cardiovascular endpoints (ischemic stroke, bleeding, heart failure) were defined based on inpatient, outpatient and pharmacy claims. Multivariable Cox models were used to estimate associations of polypharmacy with cardiovascular endpoints and the interaction between polypharmacy and AF treatments in relation to cardiovascular endpoints. Results: Prevalence of polypharmacy was 52% (176,007 of 338,810). Patients with polypharmacy had increased risk of major bleeding [hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.12, 1.20] and heart failure (HR 1.33, 95%CI 1.29, 1.36), but not of ischemic stroke (HR 0.96, 95%CI 0.92, 1.00), compared to those not with polypharmacy (Table). Polypharmacy status did not consistently modify the effectiveness of oral anticoagulants. However, rhythm control (vs. rate control) was more effective in preventing heart failure hospitalization in patients not with polypharmacy (HR 0.87, 95%CI 0.76, 0.99) than among those with polypharmacy (HR 0.98, 95%CI 0.91, 1.07, p for interaction = 0.02). Conclusion: Polypharmacy is frequent among elderly patients with AF, associated with adverse outcomes, and potentially affecting the effectiveness of AF treatments. Optimizing management of polypharmacy in elderly AF patients may lead to improved outcomes.

Sex differences of resource utilisation and outcomes in patients with atrial arrhythmias and heart failure

Heart ◽  
2019 ◽  
Vol 106 (7) ◽  
pp. 527-533 ◽  
Author(s):  
Laura Ueberham ◽  
Sebastian König ◽  
Sven Hohenstein ◽  
Rene Mueller-Roething ◽  
Michael Wiedemann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sex Differences ◽  
Hospital Mortality ◽  
Linear Mixed Model ◽  
Adverse Outcomes ◽  
Resource Utilisation ◽  
Hospital Outcomes ◽  
Risk Of Death ◽  
Increased Risk ◽  
Generalised Linear Mixed Model

ObjectiveAtrial fibrillation or atrial flutter (AF) and heart failure (HF) often go hand in hand and, in combination, lead to an increased risk of death compared with patients with just one of both entities. Sex-specific differences in patients with AF and HF are under-reported. Therefore, the aim of this study was to investigate sex-specific catheter ablation (CA) use and acute in-hospital outcomes in patients with AF and concomitant HF in a retrospective cohort study.MethodsUsing International Statistical Classification of Diseases and Related Health Problems and Operations and Procedures codes, administrative data of 75 hospitals from 2010 to 2018 were analysed to identify cases with AF and HF. Sex differences were compared for baseline characteristics, right and left atrial CA use, procedure-related adverse outcomes and in-hospital mortality.ResultsOf 54 645 analysed cases with AF and HF, 46.2% were women. Women were significantly older (75.4±9.5 vs 68.7±11.1 years, p<0.001), had different comorbidities (more frequently: cerebrovascular disease (2.4% vs 1.8%, p<0.001), dementia (5.3% vs 2.2%, p<0.001), rheumatic disease (2.1% vs 0.8%, p<0.001), diabetes with chronic complications (9.7% vs 9.1%, p=0.033), hemiplegia or paraplegia (1.7% vs 1.2%, p<0.001) and chronic kidney disease (43.7% vs 33.5%, p<0.001); less frequently: myocardial infarction (5.4% vs 10.5%, p<0.001), peripheral vascular disease (6.9% vs 11.3%, p<0.001), mild liver disease (2.0% vs 2.3%, p=0.003) or any malignancy (1.0% vs 1.3%, p<0.001), underwent less often CA (12.0% vs 20.7%, p<0.001), had longer hospitalisations (6.6±5.8 vs 5.2±5.2 days, p<0.001) and higher in-hospital mortality (1.6% vs 0.9%, p<0.001). However, in the multivariable generalised linear mixed model for in-hospital mortality, sex did not remain an independent predictor (OR 0.96, 95% CI 0.82 to 1.12, p=0.579) when adjusted for age and comorbidities. Vascular access complications requiring interventions (4.8% vs 4.2%, p=0.001) and cardiac tamponade (0.3% vs 0.1%, p<0.001) occurred more frequently in women, whereas stroke (0.6% vs 0.5%, p=0.179) and death (0.3% vs 0.1%, p=0.101) showed no sex difference in patients undergoing CA.ConclusionsThere are sex differences in patients with AF and HF with respect to demographics, resource utilisation and in-hospital outcomes. This needs to be considered when treating women with AF and HF, especially for a sufficient patient informed decision making in clinical practice.

D-dimer and the incidence of heart failure and mortality after acute myocardial infarction

Heart ◽  
2020 ◽  
pp. heartjnl-2020-316880 ◽  
Author(s):  
Xiaoyuan Zhang ◽  
Shanjie Wang ◽  
Jinxin Liu ◽  
Yini Wang ◽  
Hengxuan Cai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Plaque Rupture ◽  
Risk Of Death ◽  
Increased Risk ◽  
Clinical Covariates ◽  
All Cause Mortality ◽  
D Dimer

ObjectiveD-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. Few studies explore the association between baseline D-dimer levels and the incidence of heart failure (HF), all-cause mortality in an acute myocardial infarction (AMI) population. We aimed to explore this association.MethodsWe enrolled 4504 consecutive patients with AMI with complete data in a prospective cohort study and explored the association of plasma D-dimer levels on admission and the incidence of HF, all-cause mortality.ResultsOver a median follow-up of 1 year, 1112 (24.7%) patients developed in-hospital HF, 542 (16.7%) patients developed HF after hospitalisation and 233 (7.1%) patients died. After full adjustments for other relevant clinical covariates, patients with D-dimer values in quartile 3 (Q3) had 1.51 times (95% CI 1.12 to 2.04) and in Q4 had 1.49 times (95% CI 1.09 to 2.04) as high as the risk of HF after hospitalisation compared with patients in Q1. Patients with D-dimer values in Q4 had more than a twofold (HR 2.34; 95% CI 1.33 to 4.13) increased risk of death compared with patients in Q1 (p<0.001). But there was no association between D-dimer levels and in-hospital HF in the adjusted models.ConclusionsD-dimer was found to be associated with the incidence of HF after hospitalisation and all-cause mortality in patients with AMI.

P662Association of baseline disability and major adverse outcomes in patients with atrial fibrillation: an analysis from the SPORTIF trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Proietti ◽  
G Y H Lip
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Controlled Trial ◽  
Linear Regression Analysis ◽  
Cumulative Risk ◽  
Adverse Outcomes ◽  
Rank Test ◽  
Composite Outcome ◽  
Risk Of Death ◽  
Increased Risk

Abstract Introduction The modified Rankin Scale (mRS) is usually used to evaluate the degree of disability in patients who have suffered a stroke. Some data suggest that pre-stroke mRS may be associated with clinical outcomes. No data exist about atrial fibrillation (AF) patients. Purpose To evaluate if baseline level of disability, evaluated as mRS, is associated with major adverse outcomes in patients with AF Methods Data from the SPORTIF III and V trials were used to evaluate study aims. mRS was categorized as follows: i) mRS 0 = No Disability; ii) mRS 1 = Operational Limitation; iii) mRS ≥2 = Disability. Stroke/systemic embolism (SE), death and composite of stroke/SE/acute myocardial infarction (AMI)/death were considered as major adverse outcomes. Results Among 7329 patients enrolled in SPORTIF trials, 7325 (99.9%) had data about baseline mRS, with 5587 (76.3%) with mRS 0, 1156 (15.8%) with mRS 1 and 582 (7.9%) with mRS ≥2. Mean (SD) and median [IQR] CHA2DS2-VASc was progressively higher across the three mRS categories (both p<0.001). An adjusted linear regression analysis confirmed that mRS was associated with an increasing CHA2DS2-VASc (unstandardized B: 0.354, 95% confidence interval [CI]: 0.317–0.390, p<0.001]. After a mean (SD) 1.55 (0.40) years of follow-up 184 (2.5%) stroke/SE, 392 (5.4%) death and 597 (8.2%) composite events were recorded. Log-rank test showed that cumulative risk of stroke/SE (p=0.005), death (p<0.001) and composite outcome (p<0.001) was progressively higher across the mRS categories [Figure]. Cox adjusted regression analysis found no independent association between mRS categories and stroke/SE occurrence, but baseline disability (mRS ≥2) was independently associated with death (hazard ratio [HR]: 2.17, 95% CI: 1.65–2.86 compared with no disability). Both operational limitation (mRS 1) and disability (mRS ≥2) were associated with the composite outcome (HR: 1.28, 95% CI: 1.04–1.59 and HR: 1.91, 95% CI: 1.51–2.42, respectively) compared to no disability. Kaplan-Meier curves Conclusions In a large cohort of AF patients derived from a randomized controlled trial, baseline disability was associated with an increased risk of death and composite outcome of stroke/SEAMI/death. Acknowledgement/Funding None

Abstract P105: Women with Atrial Fibrillation have Increased Risk of Incident Stroke: Insights from a Propensity-Matched Study of the AFFIRM Trial

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Brita Roy ◽  
Ravi V Desai ◽  
Mustafa I Ahmed ◽  
Gregg C Fonarow ◽  
Wilbert S Anorow ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Propensity Scores ◽  
Cox Regression ◽  
Men And Women ◽  
Female Sex ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
All Cause Mortality ◽  
Baseline Characteristics

Background: Women with atrial fibrillation (AF) have been reported to have poor outcomes. It remains unclear if this association is intrinsic or mediated by the higher comorbidity burden of female AF patients. Therefore, we examined the association between sex and outcomes in a balanced cohort of propensity-matched AF patients who participated in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. Methods: Of the 4060 AFFIRM patients, 1594 (39%) were women. Propensity scores for female sex were calculated for each of the 4060 patients, and were used to assemble a cohort of 1097 pairs of men and women who were balanced on 51 baseline characteristics, including major cardiovascular (CV) risk factors and medication use, including warfarin. Matched Cox regression models were used to estimate the association between female sex and outcomes during 6 years of follow-up. Results: Patients (n=4060) had a mean (±SD) age of 70 (±8) years and 13% were African American. All-cause mortality occurred in 19% and 15% of matched men and women, respectively (matched HR when women were compared to men, 0.88; 95% CI, 0.69-1.11; p=0.279). All-cause hospitalization occurred in 61% of both men and women (matched HR for women, 1.06; 95% CI, 0.93-1.21; p=0.372). Sex was not associated with CV hospitalization (matched HR for women, 1.13; 95% CI, 0.97-1.32; p=0.111). Ischemic stroke occurred in 3% and 5% of matched men and women, respectively (OR when women were compared to men, 2.02; 95% CI, 1.28-3.18; p=0.002). There was no sex-related difference in major bleeding (7% each). Conclusion: In a cohort of AF patient in which men and women were well-balanced on 51 baseline characteristics including warfarin use, women had increased risk of stroke, but there was no sex-related variation in all-cause mortality or CV hospitalization.

Abstract 17216: Upright T Wave in Lead AVR and Risk of Mortality: A Systematic Review and Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
laith A derbas ◽  
Raed Qarajeh ◽  
Anas Noman ◽  
Mohammed Al Amoodi ◽  
Ala Mohsen ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Risk Scores ◽  
Risk Of Death ◽  
T Wave ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Lead Avr

Background: Multiple observational studies have shown that positive T wave in lead AVR (PTAVR) on 12-lead electrocardiogram is associated with an increased risk of adverse outcomes including death. We sought to review the literature and conduct a meta-analysis to estimate the risk of mortality in patients with PTAVR. Methods: We searched multiple databases to investigate the association between PTAVR and risk of death. Studies that reported adjusted odds ratio (OR) or hazards ratio (HR) of the association between PTAVR and risk of death (all cause or cardiovascular mortality) were included. We used inverse variance approach to pool adjusted OR /HR and it’s 95 % confidence interval using a random effects model meta-analysis. Results: Out of 140 relevant studies, 17 studies were eligible. Twelve studies reported all-cause mortality and enrolled 4,122 patients, 1976 (47.9%) were males. PTAVR was associated with a significant increase in all-cause mortality, with a pooled adjusted OR 2.44, 95% CI [1.76-3.39], heterogeneity I 2 = 86%. Five studies reported cardiovascular mortality and enrolled 31,713 patients, 27,628 (87.1%) were males. PTAVR was associated with a significant increase in cardiovascular mortality, with a pooled adjusted OR 2.34, 95% CI [1.82-3.0], heterogeneity I 2 = 68%. Conclusion: Our findings suggest that PTAVR is significantly associated with a higher risk of death from any cause as well cardiovascular mortality. Lead AVR, an often neglected lead, should be carefully interpreted as it may provide important prognostic information. Further studies are warranted to examined the prognostic value of PTAVR in risk stratification when added to existing cardiovascular risk scores.

scholarly journals The association of digoxin with mortality in ischemic heart failure: a secondary analysis of the STICH trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Pandya ◽  
D.L Brown
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Medical Therapy ◽  
Proportional Hazards ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Digoxin, one of the first treatments for symptoms of congestive heart failure (CHF), is currently used in the management of persistent CHF symptoms as well as for ventricular rate control in atrial fibrillation. Current guidelines suggest digoxin as an adjunct to optimal medical therapy for symptomatic improvement in CHF. However, the data regarding the effect of digoxin use on mortality continue to be conflicting. Purpose The aim of this retrospective study was to evaluate the association of digoxin therapy with mortality in patients with ischemic heart failure defined by severe left ventricular (LV) dysfunction and coronary artery disease (CAD) in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Methods STICH randomized 1012 patients with CAD and LV ejection fraction&lt;35% to coronary artery bypass graft (CABG) surgery and medical therapy vs. medical therapy alone. Factors predictive of digoxin use were identified with a binomial logistic regression model. Multivariable Cox proportional hazards modelling was performed with digoxin use modelled as a segmented time-dependent covariate. The model was adjusted for baseline clinical characteristics (including age, race, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, NYHA heart failure class, previous myocardial infarction, atrial fibrillation, creatinine level, smoking status, and STICH treatment group) and stratified based on sex. All covariates were verified to meet the proportional hazards assumption. The primary outcome was all-cause mortality. Secondary outcomes included death and hospitalization due to cardiovascular causes. Relative risks were expressed as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Results Of the 1012 patients, 351 (35% [36% of male patients and 27% of female patients]) reported digoxin use for some duration during the study period. Significant predictors of digoxin use included minority status, NYHA class, previous myocardial infarction, and baseline diagnosis of hypertension, diabetes, or atrial fibrillation. At a mean follow-up of 9.8 years, 566 patients (55.7%) experienced all-cause mortality and 387 patients (38.1%) died due to cardiovascular causes. The adjusted Cox proportional hazards model demonstrated that digoxin use was independently associated with an increased risk of all-cause mortality (aHR 1.22, 95% CI: 1.00–1.49, P=0.049). Digoxin use was also associated with increased risk of cardiovascular death (aHR 1.29, 95% CI: 1.02–1.64, P=0.032). There was no impact of digoxin on hospitalization for cardiovascular causes. Conclusion Use of digoxin in patients with ischemic heart failure was associated with an increased risk of both all-cause and cardiovascular death. Funding Acknowledgement Type of funding source: None

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