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

• Published in: Journal of cardiovascular development and disease 2024-06, Vol.11 (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: Article
• Language: English
• 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
• ISSN: 2308-3425; 2308-3425
• DOI: 10.3390/jcdd11060173

(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.