Digoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure
Digoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure
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DOI：
10.1016/j.amjmed.2013.08.027
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发表时间：
2014-01-01
影响因子：
5.9
通讯作者：
Allman, Richard M.
中科院分区：
文献类型：
--
作者：
Ahmed, Ali;Bourge, Robert C.;Allman, Richard M.
背景：心力衰竭是再次入院的主要原因，根据《平价医疗法案》，减少再次入院是一个优先事项。地高辛可减少慢性收缩性心力衰竭患者30天全因住院治疗。地高辛是否能有效减少急性失代偿住院后的再入院率仍是未知数：在5153名因急性心力衰竭住院且未接受地高辛的医疗保险受益人中，1054名（20%）接受了地高辛的新出院处方。对5153名患者的地高辛使用倾向评分进行估计，用于组成1842名患者的匹配队列（921对）患者（平均年龄76岁; 56%为女性; 25%为非洲裔美国人）接受和未接受地高辛治疗，在55项基线特征上保持平衡。在接受和未接受地高辛的匹配患者中，30天全因再入院的发生率分别为17%和22%（地高辛的风险比[HR]为0.77; 95%置信区间[CI]为0.63-0.95）。只有射血分数< 45%的患者才能观察到这种有益的相关性（HR 0.63; 95% CI，0.47-0.83），但射血分数>= 45%的患者中未发生（HR 0.91; 95% CI，0.60-1.37;相互作用的P值为0.145），这种差异在出院后的前12个月一直存在（相互作用的P值为0.019）。12个月心力衰竭再入院和全因死亡率的HR（95% CI）为0.72（0.61-0.86）和0.83（0.70-0.98）。在患有收缩性心力衰竭的医疗保险受益人中，地高辛的出院处方与30天全因再入院率较低相关，该再入院率维持在12个月，而不是以更高的死亡率为代价。需要进一步的随机对照试验来证实这些发现。(C)2014爱思唯尔公司All rights reserved.
BACKGROUND: Heart failure is the leading cause for hospital readmission, the reduction of which is a priority under the Affordable Care Act. Digoxin reduces 30-day all-cause hospital admission in chronic systolic heart failure. Whether digoxin is effective in reducing readmission after hospitalization for acute decompensation remains unknown.METHODS: Of the 5153 Medicare beneficiaries hospitalized for acute heart failure and not receiving digoxin, 1054 (20%) received new discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 5153 patients, were used to assemble a matched cohort of 1842 (921 pairs) patients (mean age, 76 years; 56% women; 25% African American) receiving and not receiving digoxin, who were balanced on 55 baseline characteristics.RESULTS: Thirty-day all-cause readmission occurred in 17% and 22% of matched patients receiving and not receiving digoxin, respectively (hazard ratio [HR] for digoxin, 0.77; 95% confidence interval [CI], 0.63-0.95). This beneficial association was observed only in those with ejection fraction < 45% (HR 0.63; 95% CI, 0.47-0.83), but not in those with ejection fraction >= 45% (HR 0.91; 95% CI, 0.60-1.37; P for interaction,.145), a difference that persisted throughout the first 12 months postdischarge (P for interaction, .019). HRs (95% CIs) for 12-month heart failure readmission and all-cause mortality were 0.72 (0.61-0.86) and 0.83 (0.70-0.98), respectively.CONCLUSIONS: In Medicare beneficiaries with systolic heart failure, a discharge prescription of digoxin was associated with lower 30-day all-cause hospital readmission, which was maintained at 12 months, and was not at the expense of higher mortality. Future randomized controlled trials are needed to confirm these findings. (C) 2014 Elsevier Inc. All rights reserved.