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      We thank Temtanakitpaisan et al for their interest and agree that newer randomized control trials of digoxin in contemporary patients with systolic heart failure may be needed for clinical practice to change.

      Douglas D. Digoxin may cut heart failure readmission in the elderly. Available at: http://www.thedoctorschannel.com/view/digoxin-may-cut-heart-failure-readmission-in-the-elderly/.

      The efficacy of digoxin in reducing the risk of hospitalization due to worsening heart failure was clearly established in the Digitalis Investigation Group trial, and this effect has been shown to be more pronounced in those in the high-risk subgroup.
      • Gheorghiade M.
      • Patel K.
      • Filippatos G.
      • et al.
      Effect of oral digoxin in high-risk heart failure patients: a pre-specified subgroup analysis of the DIG trial.
      We have demonstrated that the effect of digoxin on hospital admission is early and broad, resulting in a significant reduction in the risk of 30-day all-cause admission in systolic heart failure,
      • Bourge R.C.
      • Fleg J.L.
      • Fonarow G.C.
      • et al.
      Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure.
      but not in diastolic heart failure.
      • Hashim T.
      • Elbaz S.
      • Patel K.
      • et al.
      Digoxin and 30-day all-cause hospital admission in older patients with chronic diastolic heart failure.
      We also have demonstrated that digoxin use is associated with lower 30-day all-cause readmission in real-world patients with systolic heart failure,
      • Ahmed A.
      • Bourge R.C.
      • Fonarow G.C.
      • et al.
      Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure.
      including those receiving beta-blockers.
      • Hashim T.
      • Parvataneni S.
      • Fonarow G.C.
      • et al.
      Discharge initiation of digoxin is associated with lower 30-day all-cause readmission in hospitalized older patients with heart failure and reduced ejection fraction receiving beta-blockers.
      Heart failure is the leading cause for 30-day all-cause readmission. Under pressure to avoid cuts in Medicare payments because of above-average 30-day all-cause readmission mandated by the Affordable Care Act, hospitals are adopting various transition of care strategies based on single-center reports, post hoc analyses, observational studies, and expert opinion. Despite limitations of the cost-driven metric of 30-day all-cause hospital readmission, the fact remains that one quarter of hospitalized patients with heart failure are readmitted within 30 days of hospital discharge. On the basis of the totality of existing evidence, we believe that it is reasonable for physicians to consider digoxin for patients with heart failure and ejection fraction <45% to reduce 30-day all-cause hospital readmission.

      References

      1. Douglas D. Digoxin may cut heart failure readmission in the elderly. Available at: http://www.thedoctorschannel.com/view/digoxin-may-cut-heart-failure-readmission-in-the-elderly/.

        • Gheorghiade M.
        • Patel K.
        • Filippatos G.
        • et al.
        Effect of oral digoxin in high-risk heart failure patients: a pre-specified subgroup analysis of the DIG trial.
        Eur J Heart Fail. 2013; 15: 551-559
        • Bourge R.C.
        • Fleg J.L.
        • Fonarow G.C.
        • et al.
        Digoxin reduces 30-day all-cause hospital admission in older patients with chronic systolic heart failure.
        Am J Med. 2013; 126: 701-708
        • Hashim T.
        • Elbaz S.
        • Patel K.
        • et al.
        Digoxin and 30-day all-cause hospital admission in older patients with chronic diastolic heart failure.
        Am J Med. 2014; 127: 132-139
        • Ahmed A.
        • Bourge R.C.
        • Fonarow G.C.
        • et al.
        Digoxin use and lower 30-day all-cause readmission for Medicare beneficiaries hospitalized for heart failure.
        Am J Med. 2014; 127: 61-70
        • Hashim T.
        • Parvataneni S.
        • Fonarow G.C.
        • et al.
        Discharge initiation of digoxin is associated with lower 30-day all-cause readmission in hospitalized older patients with heart failure and reduced ejection fraction receiving beta-blockers.
        Circulation. 2013; 128: A16811

      Linked Article

      • Use of Digoxin in Chronic Systolic Heart Failure in Current Era
        The American Journal of MedicineVol. 128Issue 1
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          We thank Bourge et al1 for their article titled “Digoxin Reduces 30-day All-cause Hospital Admission in Older Patients with Chronic Systolic Heart Failure,” which was published in The American Journal of Medicine. The authors demonstrated benefit of digoxin in reduction of 30-day all-cause hospital admission based on the main Digitalis Investigation Group (DIG) trial. This is very relevant in the current era because heart failure is a leading cause of hospitalization and re-hospitalization in the elderly.
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