Digoxin therapy and the risk of primary cardiac arrest in patients with congestive heart failure: Effect of mild–moderate renal impairment

Rea, Thomas D.; Siscovick, David S.; Psaty, Bruce M.; Pearce, Rachel M.; Raghunathan, Trivellore E.; Whitsel, Eric A.; Cobb, Leonard A.; Weinmann, Sheila; Anderson, Gail D.; Arbogast, Patrick; Lin, Danyu

doi:10.1016/S0895-4356(03)00075-1

« Previous Next »Journal of Clinical Epidemiology
Volume 56, Issue 7 , Pages 646-650, July 2003

Digoxin therapy and the risk of primary cardiac arrest in patients with congestive heart failure:

Effect of mild–moderate renal impairment

Thomas D. Rea
- Cardiovascular Health Research Unit, University of Washington, Department of Medicine, Metropolitan Park, 1730 Minor Avenue, East Tower, Seattle, WA 98101, USA
- Corresponding author. Tel.: 206-287-2777; fax: 206-287-2662.
David S. Siscovick
- Cardiovascular Health Research Unit, University of Washington, Department of Medicine, Metropolitan Park, 1730 Minor Avenue, East Tower, Seattle, WA 98101, USA
- Department of Epidemiology, University of Washington, Box 357236 NE Pacific Street, Seattle, WA 98195, USA
Bruce M. Psaty
- Department of Epidemiology, University of Washington, Box 357236 NE Pacific Street, Seattle, WA 98195, USA
- Department of Health Services, University of Washington, Box 357660 NE Pacific Street, Seattle, WA 98195, USA
Rachel M. Pearce
- Cardiovascular Health Research Unit, University of Washington, Department of Medicine, Metropolitan Park, 1730 Minor Avenue, East Tower, Seattle, WA 98101, USA
Trivellore E. Raghunathan
- Institute for Social Research, University of Michigan, PO Box 1248, 426 Thompson Street, Ann Arbor, MI 481006, USA
Eric A. Whitsel
- Department of Medicine, University of North Carolina, CB #7005 3033 Old Clinic Building, Chapel Hill, NC 27599, USA
Leonard A. Cobb
- Cardiovascular Health Research Unit, University of Washington, Department of Medicine, Metropolitan Park, 1730 Minor Avenue, East Tower, Seattle, WA 98101, USA
Sheila Weinmann
- Cardiovascular Health Research Unit, University of Washington, Department of Medicine, Metropolitan Park, 1730 Minor Avenue, East Tower, Seattle, WA 98101, USA
Gail D. Anderson
- Department of Pharmacy, University of Washington, Box 357630 NE Pacific Street, Seattle, WA 98195, USA
Patrick Arbogast
- Department of Biostatistics, Vanderbilt University, 1161 21^st Avenue, Nashville, TN 37232, USA
Danyu Lin
- Department of Biostatistics, University of North Carolina, CB #7420 3101 E McGavran-Greenburg Hall, Chapel Hill, NC 27599, USA

Abstract

Background and Objective: The cardiac safety of digoxin therapy for congestive heart failure (CHF) is a source of concern, especially among those with renal impairment.

Methods: Using a case–control design, we examined the risk of primary cardiac arrest (PCA) associated with digoxin therapy within three levels of renal function.

Results: After adjustment for other clinical characteristics, digoxin therapy for CHF was not associated with an increased risk of PCA [odds ratio (OR)=0.97, 95% confidence interval (CI) 0.59–1.62] among patients with normal renal function (serum creatinine ⩽1.1 mg/dL). In contrast, digoxin therapy was associated with a modest increase in risk (OR=1.58, CI 0.89–2.80) among patients with mild renal impairment (serum creatinine=1.2–1.4 mg/dL); and a twofold increase in risk (OR=2.39, CI 1.37–4.18) among patients with moderate renal impairment (serum creatinine=1.5–3.5 mg/dL).

Conclusions: These findings suggest that the risks of digoxin may offset the benefits among patients with moderately impaired renal function, but not among patients with normal renal function.

Keywords: Heart arrest, Digoxin, Kidney, Heart failure