THE EFFECT OF DIGOXIN ON MORTALITY AND MORBIDITY IN PATIENTS WITH HEART-FAILURE

Authors
PERRY G BROWN E THORNTON R SHIVA T HUBBARD J REDDY KR DOHERTY JE CARDELLO FP FAST A RADFORD MJ FOLGER JS BHASKAR G ZOBLE RG SRIDHARAN V SRIDHARAN MR LOUNGANI RR GHEORGHIADE M HSIEH A TOMMASO C MANSURI M GUESS MA AKHTAR S WAGNER S HAGAN K MCINTYRE KM RUBLE P MOTEN M RILEY A PIERPONT G ANAND I PATEL G PURAM BS ELADASARI BR KARNEGIS J GILLIE E CRAWFORD MH GRAETTINGER WF SHAH A SACCO J CHAUDHRY MA DOLEN D ELSHERIF N BEKHEITSAAD S CAMPOS EE GREENE JG KHANIJO V KUMAR U MALLIS GI MOOKHERJEE S DIBNERDUNLAP M GUPTA SC DANISA K THADANI U TAN A RAJACHAR M AMIDI M OREILLY MV HASSAPOYANNES CA DAVIES ML KUMAR VA OKERSON D RAMANATHAN KB PUTATUNDA B GOLLAPUDI A MONTERO A MOHANTY PK LUI C THAGIRISA S LEE RW GLATTER TR BODINE K ROBERTS D BERTOGLIO M DENNISH GW SARMA RJ GREGORATOS G RAUSCH DC PITT WA KENNELLY BM FAHRENHOLTZ D GORDON R HORWITZ L ROTHBART R NUTTING P LUTZ L COPEN DL RASHKOW A BABB J VANVOORHEES L SILVERMAN A STILLABOWER ME MILLER AB NGUYENPHO HT SAFFORD RE FISHMAN S NEIMAN JC STEIN M DOMINGUEZ JC ABERNATHY GT NAIR PH GOODMAN LS COOK TH WICKEMEYER WJ BERKSON DM MATHEW J RICHMAN HG LUBELL DL LANG R ZAJAC EJ ROSENSTEIN R SILVER MA SHANES JG KELLY KJ PEQUIGNOT MH CAMPBELL R KIRLIN PC ZIPERMAN DB DENNY DM GAMBLE L WEISS M KAIMAL PK DHURANDHAR RW VENTURA H GODLEY ML PU C SCHICK EC BARBOUR DJ SALMON D GOLDSTEIN M EFFRON MB FLEG JL BAUGHMAN KL WEISS R ERICSON K STURROCK WA HEINSIMER J TIMMIS GC SMITH S SHRESTHA DD DUVERNOY WFC HICKNER J LEWIS BK OBRIEN TK YAROWS SA WILLENS HJ MAST DJ JOHNSON TH RODEHEFFER RJ SIEFERT M SWENSON L DENES P GUDAPATI R CHARLES FR RICH MW BECKHAM V HAMILTON WP ABELE PB HARPER DM OKELLY RL FORKER AD KAHL FR GARROU BW KLANG TE POPIO K MOHIUDDIN S POLLAK EM CHIARAMIDA A GREGORY JJ PAPA LA ABRAMS J UNG S JUTILA CK CROKE RP CHIARAMIDA S LUCARIELLO R RIM DA GOLDBERGER MH KOHN RM GRAHAM S PHILBIN EF SHEESLEY K NAFZIGER A MACINA G HSUEH JT ZONERAICH S BINDER A WEINSTEIN C MORRISON J CAMERON A VANDERBUSH E BROWN J PANDE PN LADER E KAY R BLOOMFIELD D COSTANTINO T HEISELMAN DE RADWANY S SMITH MR HOBBS RE FRAKER TD FRERKING TR DELEON AC CHRISTIE LG TOREN M GROVER J MCBARRON FD HARRIS DE MCLEAN RW MORRIS L ZATUCHNI J BOEHMER JP CLEMSON BS LIPSHUTZ H SMALL RS UFRET R LUGORODRIQUEZ JE KHAN AH YOUSEFIAN M FRIESINGER GC ELY D FARMER JA YOUNG JB PAYNE RM FOWLES RE LEE AB SHALEV Y ALBITAR I SCHROEDER GS RADANT L HANKEY TL REZKALLA S GRODEN DL TEO KK HUMEN DP WONG D GREENWOOD PV TALIBI T HUI W KLINKE WP SENARATNE MPJ GOERES M HUGHES DF SAYEED MAR ROTH DL BELENKIE I MANYARI DE BORGERSEN K READ L KINLOCH D REID R BARBER NC HORNER BA KENEFICK G KURITZKY RA IMRIE JR WAGNER KR RABKIN SW MIZGALA HF TARRY L DODEK A KORNDER JM ASHTON T BARR D DUFTON J SWEENY R MORRIS A BESSOUDO R MARR D MILTON JR THOMPSON B ROBINSON V SUSSEX BA TOBIN M MCMAHON DP FOLKINS D CROWELL R LALONDE LD KOILPILLAI C HATHEWAY RJ OREILLY MG MACHEL T HACK I STEWART JW TANSER PH SULLIVAN B HAGAR S QUINN B DAVIES RA BAIRD MG WILLIAMS WL LEMAY M HIGGINSON L TUREK M SOCHOWSKI RA WEEKS A JACOBS MH BAIGRIE R DEVILLA MA VERTES G BOZEK B GOODE JE RICCI AJ SWAN J FELL DA LEVINOFFROTH SN ARNOLD JMO PATRICK L SOUTHERN RF RINNE C BRISBIN D DEYOUNG JP BAITZ T VIZEL S MINKOWITZ J LETARTE P CHAN YK KWOK KK NAWAZ S GANJAVI F YAO L MISTERSKI J RACO DL HESS AR KURUVILLA G SILVERBERG L BORTS D FULOP JC WEINGERT ME CARTER RP SAHAY BM HICKEY JE LALONDE G GOSSELIN G BOURASSA MG GOULET C JOYAL M METHE M HONOS G FITCHETT D SERPA A SESTIER F ROBERGE G LATOUR Y RONDEAU C GOSSARD D LENIS JHF BROSSOIT R SIMARD L DELAGE F AUGER P SAULNIER D TALBOT P BEAUDOIN J CAMPEAU J PRUNEAU G TAMILIA M BOUTROS G COMEAU B STARRA R STHILAIRE R VEILLEUX J MERCIER M POULIN JF MACLELLAN K LEPAGE S ROULEAU JL BRUINSMA N LEVESQUE C DELAROCHELLIERE R LEBLANC M KOUZ S KIWAN GS LAFOREST M BROOKS J BOUCHARD G GERVAIS PB BROPHY J GAGNON J HABIB N BASU AK LUTTERODT AT KHOURI M GORLIN R EGAN D GARG R YUSUF S MONTAGUE T SMITH TW COHN JN DAGENAIS GR DAVIES R JOHNSTONE DE FYE C SATHER MR DEYKIN D FRANCIS G COLLINS JF WILLIFORD WO SINGH BN
Citation
G. Perry et al., THE EFFECT OF DIGOXIN ON MORTALITY AND MORBIDITY IN PATIENTS WITH HEART-FAILURE, The New England journal of medicine, 336(8), 1997, pp. 525-533
Citations number
11
Categorie Soggetti
Medicine, General & Internal
Journal title
The New England journal of medicine → ACNP
ISSN journal
00284793
Volume
336
Issue
8
Year of publication
1997
Pages
525 - 533
Database
ISI
SICI code
0028-4793(1997)336:8<525:TEODOM>2.0.ZU;2-V
Abstract
Background The role of cardiac glycosides in treating patients with ch ronic heart failure and normal sinus rhythm remains controversial. We studied the effect of digoxin on mortality and hospitalization in a ra ndomized, double-blind clinical trial. Methods In the main trial, pati ents with left ventricular ejection fractions of 0.45 or less were ran domly assigned to digoxin (3397 patients) or placebo (3403 patients) i n addition to diuretics and angiotensin-converting-enzyme inhibitors ( median dose of digoxin, 0.25 mg per day; average follow-up, 37 months) . In an ancillary trial of patients with ejection fractions greater th an 0.45, 492 patients were randomly assigned to digoxin and 496 to pla cebo. Results In the main trial, mortality was unaffected. There were 1181 deaths (34.8 percent) with digoxin and 1194 deaths (35.1 percent) with placebo (risk ratio when digoxin was compared with placebo, 0.99 ; 95 percent confidence interval, 0.91 to 1.07; P = 0.80). In the digo xin group, there was a trend toward a decrease in the risk of death at tributed to worsening heart failure (risk ratio, 0.88; 95 percent conf idence interval, 0.77 to 1.01; P = 0.06). There were 6 percent fewer h ospitalizations overall in that group than in the placebo group, and f ewer patients were hospitalized for worsening heart failure (26.8 perc ent vs. 34.7 percent; risk ratio, 0.72; 95 percent confidence interval , 0.66 to 0.79; P < 0.001). In the ancillary trial, the findings regar ding the primary combined outcome of death or hospitalization due to w orsening heart failure were consistent with the results of the main tr ial. Conclusions Digoxin did not reduce overall mortality, but it redu ced the rate of hospitalization both overall and for worsening heart f ailure. These findings define more precisely the role of digoxin in th e management of chronic heart failure. (C) 1997, Massachusetts Medical Society.