Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT-Recipients

(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator...

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Published in:	Journal of cardiovascular development and disease Vol. 11; no. 6; p. 173
Main Authors:	Erath, Julia W, Vigh, Nikolett, Muk, Balazs, Israel, Carsten W, Keck, Sarah, Pilecky, David, Duray, Gabor Z, Vamos, Mate
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 01-06-2024 MDPI
Subjects:	Cardiac arrhythmia Cardiac patients cardiac resynchronization therapy Cardiovascular disease Care and treatment CRT-D Data collection defibrillator Defibrillators Diabetes digitalis digitoxin digoxin Germany Heart failure Heart rate Hospitalization Hungary Hypertension Ischemia Kidney diseases Medical care, Cost of Medical equipment and supplies industry Medical test kit industry Mortality Patients Risk factors Sinuses Survival analysis United States Hungary United States Germany United States > US Chicago Illinois cardiac resynchronization therapy digitalis digitoxin mortality congestive heart failure CRT-D digoxin CRT-response defibrillator
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Summary:	(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed-up for a mean 37 months ± 28 months. Digitalis use was assessed at the time of CRT implantation. A multivariate Cox-regression model and propensity score matching were used to determine all-cause mortality as the primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%) and incidence of ICD shocks and rehospitalization were assessed as secondary endpoints in a subgroup of patients. (3) Results: The study comprised 552 CRT-recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and a higher NYHA class (all ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR = 1.14; 95% CI 0.88-1.5; = 0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR = 1.04; 95% CI 0.75-1.45; = 0.82). Furthermore, in comparison to 286 propensity-score-matched patients, mortality was not affected by digitalis intake (propensity-adjusted HR = 1.11; 95% CI 0.72-1.70; = 0.64). A CRT-response was predominant in digitalis non-users, concerning both improvement of HF symptoms and LVEF (NYHA < 0.01; LVEF < 0.01), while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock ( = 0.01); although, rehospitalization for cardiac reasons was significantly lower among digitalis users compared to digitalis non-users (HR = 0.58; 95% C. I. 0.40-0.85; = 0.01). (4) Conclusions: Digitalis therapy had no effect on mortality, but was associated with a reduced response to CRT and increased susceptibility to ventricular arrhythmias requiring ICD shock treatment. Although, digitalis administration positively altered the likelihood for cardiac rehospitalization during follow-up.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2308-3425 2308-3425
DOI:	10.3390/jcdd11060173