{"id":35579,"date":"2013-03-21T08:00:51","date_gmt":"2013-03-21T12:00:51","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=35579"},"modified":"2013-03-21T12:58:34","modified_gmt":"2013-03-21T16:58:34","slug":"digging-in-three-reasons-why-the-recent-digoxin-study-is-not-relevant-to-readmission","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/03\/21\/digging-in-three-reasons-why-the-recent-digoxin-study-is-not-relevant-to-readmission\/","title":{"rendered":"DIGging In: Three Reasons Why the Recent Digoxin Study Is Not Relevant to Readmission"},"content":{"rendered":"

Ali Ahmed of the University of Alabama presented an analysis of the DIG trial<\/a> at the ACC (and simultaneously published in the American Journal of Medicine<\/a>). In short, the researchers randomized some 3400 outpatients aged 65 years or older with chronic heart failure to receive digoxin or placebo. The primary outcome of all-cause hosptialization within 30 days occurred in 5.4% (92\/1693) of digoxin-treated patients and 8.1% (139\/1712) of placebo-recipients. The trial is being promoted as new information to decrease readmissions. Ahmed is quoted in MedPage Today<\/a> as saying “If these findings can be replicated in contemporary older heart failure patients discharged from hospital after acute decompensation, digoxin may provide an inexpensive tool to reduce 30-day all-cause hospital readmission.”<\/p>\n

Here are 3 reasons why this study is not relevant to efforts to reduce readmission.<\/p>\n

    \n
  1. The study is not about readmissions. The DIG trial enrolled ambulatory patients and the study reports 30-day hospitalization rates. The relevance of hospitalization rates of ambulatory patients enrolled in a clinical trial to readmission rates is not known. Patients who are recently hospitalized have a dramatically elevated risk for a wide range of clinical outcomes. The admission rates of patients enrolled in a clinical trial are much lower and are not affected by a recent hospitalization.<\/li>\n
  2. The research is dated. The DIG trial was conducted decades ago and practice has evolved considerably since then. The relevance of hospitalization rates for patients at that time for readmission rates now is not clear.<\/li>\n
  3. The evidence is weak. The study is a post-hoc, retrospective analysis of a trial that reported lower admission rates, which was a secondary outcome. Moreover, the overall trial was negative for its primary endpoint \u2013 and a later analysis that our group conducted revealed that women experienced a higher mortality rate on digoxin \u2013 and that the therapeutic window for digoxin was quite narrow.<\/li>\n<\/ol>\n

    It would be wonderful if an inexpensive medication could dramatically reduce readmission risk for patients with heart failure. As far as I can see, however, this study has no relevance to that issue. Doctors should not start prescribing digoxin as a result of headlines reporting that this study supports that strategy.<\/p>\n","protected":false},"excerpt":{"rendered":"

    The evidence is just not compelling that this this drug would reduce hospital readmissions<\/p>\n","protected":false},"author":211,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,14],"tags":[1711,1735,1736,700],"class_list":["post-35579","post","type-post","status-publish","format-standard","hentry","category-general","category-heart-failure","tag-acc-13","tag-dig-trial","tag-digoxin","tag-hospital-readmissions"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/35579","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/211"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=35579"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/35579\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=35579"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=35579"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=35579"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}