J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 8, August 2022, pages 315-320

Impact of Digoxin Use on Guideline-Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction

**Table 1.** Baseline Characteristics and Comorbidities
	Digoxin (n = 34)	Without digoxin (n = 199)	P value
The threshold of significance is P < 0.05. ±: standard deviation. CKD: chronic kidney disease; CAD: coronary artery disease; DM: diabetes mellites; NYHA: New York Heart Association Functional Classification; LV: left ventricular.
Age (years)	64 (± 15.0)	60.1(±16.1)	0.19
Female	12 (35.3%)	76 (38.2%)	0.33
Race			0.24
White	21 (61.8%)	126 (63.3%)
Blacks	9 (26.5%)	37 (18.6%)
Others	4 (11.8%)	3 (18.1%)
Weight	98 (67 - 110)	93 (73 - 113)	0.35
Height	165 (160 - 176)	164 (160 - 167)	0.27
Tobacco use (active/former)	22 (64.7%)	115 (57.8%)	0.45
DM	13 (38.2%)	84 (42.2%)	0.65
Hypertension	26 (76.5%)	167 (83.9%)	0.89
Atrial fibrillation	23 (67.7%)	144 (72.4%)	0.78
CKD	15 (44.1%)	53 (26.6%)	0.89
CAD	14 (41.2%)	35 (17.6%)	0.76
Depression	5 (14.7%)	14 (7.0%)	0.44
NYHA			0.41
Class I - II	13 (38.2%)	90 (48.1%)
Class III - IV	21 (61.8%)	97 (51.9%)
LV ejection fraction	22.5 (± 9.2)	26.3 (± 8.7)	0.02
Follow-up duration, days	272.2 (± 116.9)	213.2 (± 125.4)	0.01

Table 1. Baseline Characteristics and Comorbidities

Digoxin (n = 34)

Without digoxin (n = 199)

P value

The threshold of significance is P < 0.05. ±: standard deviation. CKD: chronic kidney disease; CAD: coronary artery disease; DM: diabetes mellites; NYHA: New York Heart Association Functional Classification; LV: left ventricular.

Age (years)

64 (± 15.0)

60.1(±16.1)

0.19

Female

12 (35.3%)

76 (38.2%)

0.33

Race

0.24

White

21 (61.8%)

126 (63.3%)

Blacks

9 (26.5%)

37 (18.6%)

Others

4 (11.8%)

3 (18.1%)

Weight

98 (67 - 110)

93 (73 - 113)

0.35

Height

165 (160 - 176)

164 (160 - 167)

0.27

Tobacco use (active/former)

22 (64.7%)

115 (57.8%)

0.45

13 (38.2%)

84 (42.2%)

0.65

Hypertension

26 (76.5%)

167 (83.9%)

0.89

Atrial fibrillation

23 (67.7%)

144 (72.4%)

0.78

CKD

15 (44.1%)

53 (26.6%)

0.89

CAD

14 (41.2%)

35 (17.6%)

0.76

Depression

5 (14.7%)

14 (7.0%)

0.44

NYHA

0.41

Class I - II

13 (38.2%)

90 (48.1%)

Class III - IV

21 (61.8%)

97 (51.9%)

LV ejection fraction

22.5 (± 9.2)

26.3 (± 8.7)

0.02

Follow-up duration, days

272.2 (± 116.9)

213.2 (± 125.4)

0.01

**Table 2.** Labs and Vitals for First and Last Visit
Variable	First visit	Last visit
The threshold of significance is P < 0.05. ±: standard deviation. HR: heart rate; bpm: beat per minute; SBP: systolic blood pressure; DBP: diastolic blood pressure; BUN: blood urea nitrogen.
HR (bpm)	75.2 (± 12.8)	77.9 (± 14.4)	0.331	74.3 (± 11.5)	73.5 (± 13)	0.79
SBP (mm Hg)	110.8 (± 15.4)	123.1 (± 18.8)	< 0.01	110.9 (± 16.3)	118.1 (± 17.6)	0.03
DBP (mm Hg)	65.4 (± 11.8)	71.6 (± 12.9)	0.01	66.6 (± 11.7)	66.9 (± 11.7)	0.89
Sodium (mmol/L)	137 (± 2.6)	138 (± 3.2)	0.01	138.2 (± 2.7)	138.6 (± 2.8)	0.56
Potassium (mmol/L)	4.2 (± 0.36)	4.3 (± 0.56)	0.49	4.5 (± 0.49)	4.69 (± 3.5)	0.81
BUN (mg/dL)	29.36 (± 19.3)	26.9 (± 18.63)	0.49	33.7 (± 22)	28 (± 22.1)	0.26
Creatinine (mg/dL)	1.3 (± 0.69)	1.4(± 1)	0.81	1.3 (± 0.38)	1.4 (± 0.79)	0.69

Table 2. Labs and Vitals for First and Last Visit

Variable

First visit

Last visit

Digoxin (n = 34)

Without digoxin (n = 199)

P value

Digoxin (n = 34)

Without digoxin (n = 199)

P value

The threshold of significance is P < 0.05. ±: standard deviation. HR: heart rate; bpm: beat per minute; SBP: systolic blood pressure; DBP: diastolic blood pressure; BUN: blood urea nitrogen.

HR (bpm)

75.2 (± 12.8)

77.9 (± 14.4)

0.331

74.3 (± 11.5)

73.5 (± 13)

0.79

SBP (mm Hg)

110.8 (± 15.4)

123.1 (± 18.8)

< 0.01

110.9 (± 16.3)

118.1 (± 17.6)

0.03

DBP (mm Hg)

65.4 (± 11.8)

71.6 (± 12.9)

0.01

66.6 (± 11.7)

66.9 (± 11.7)

0.89

Sodium (mmol/L)

137 (± 2.6)

138 (± 3.2)

0.01

138.2 (± 2.7)

138.6 (± 2.8)

0.56

Potassium (mmol/L)

4.2 (± 0.36)

4.3 (± 0.56)

0.49

4.5 (± 0.49)

4.69 (± 3.5)

0.81

BUN (mg/dL)

29.36 (± 19.3)

26.9 (± 18.63)

0.49

33.7 (± 22)

28 (± 22.1)

0.26

Creatinine (mg/dL)

1.3 (± 0.69)

1.4(± 1)

0.81

1.3 (± 0.38)

1.4 (± 0.79)

0.69

**Table 3.** Bivariate Analysis Comparing Highest Tolerated Doses Guideline-Directed Medical Therapy Between Patients With HFrEF on Digoxin and Those not on Digoxin
	Digoxin (n = 34)	Without digoxin (n = 199)	P value
The threshold of significance is P < 0.05. ±: standard deviation. ACEIs: angiotensin-converting enzyme inhibitors; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor-neprilysin inhibitor; MRA: mineralocorticoid receptor antagonist.
β-blocker dose					0.235
None	1 (2.9%)	1 (2.9%)	13 (6.5%)	4 (2%)
Minimum	23 (67.6%)	15 (44.1%)	102 (51.3%)	66 (33.2%)
Intermediate	3 (8.8%)	9 (26.5%)	51 (25.6%)	42 (21.1%)
Maximum	7 (20.6%)	9 (26.5%)	33 (16.6%)	87 (43.7%)
ACEI/ARB dose					0.903
None	16 (47%)	26 (76.5%)	113 (56.8%)	153 (76.9%)
Minimum	13 (38.2%)	4 (11.8%)	56 (28.1%)	21 (10.6%)
Intermediate	5 (14.7%)	2 (5.9%)	21 (10.6%)	16 (8%)
Maximum	0	2 (5.9%)	9 (4.5%)	9 (4.5%)
ARNI dose					0.717
None	20 (58.8%)	8 (23.5%)	116 (58.3%)	68 (34.2%)
Minimum	5 (14.7%)	7 (20.6%)	51 (25.6%)	26 (13.1%)
Intermediate	5 (14.7%)	7 (20.6%)	24 (12.1%)	31 (15.6%)
Maximum	4 (11.8%)	12 (35.3%)	8 (4%)	74 (37.2%)
MRA					0.331
None	26 (76.5%)	21 (61.8%)	135 (67.8%)	96 (48.2%)
Intermediate	3 (8.8%)	5 (14.7%)	15 (7.5%)	31 (15.6%)
Maximum	5 (14.7%)	8 (23.5%)	49 (24.6%)	72 (36.2%)

Table 3. Bivariate Analysis Comparing Highest Tolerated Doses Guideline-Directed Medical Therapy Between Patients With HFrEF on Digoxin and Those not on Digoxin

Digoxin (n = 34)

Without digoxin (n = 199)

P value

First visit

Last visit

First visit

Last visit

The threshold of significance is P < 0.05. ±: standard deviation. ACEIs: angiotensin-converting enzyme inhibitors; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor-neprilysin inhibitor; MRA: mineralocorticoid receptor antagonist.

β-blocker dose

0.235

None

1 (2.9%)

13 (6.5%)

4 (2%)

Minimum

23 (67.6%)

15 (44.1%)

102 (51.3%)

66 (33.2%)

Intermediate

3 (8.8%)

9 (26.5%)

51 (25.6%)

42 (21.1%)

Maximum

7 (20.6%)

9 (26.5%)

33 (16.6%)

87 (43.7%)

ACEI/ARB dose

0.903

None

16 (47%)

26 (76.5%)

113 (56.8%)

153 (76.9%)

Minimum

13 (38.2%)

4 (11.8%)

56 (28.1%)

21 (10.6%)

Intermediate

5 (14.7%)

2 (5.9%)

21 (10.6%)

16 (8%)

Maximum

2 (5.9%)

9 (4.5%)

ARNI dose

0.717

None

20 (58.8%)

8 (23.5%)

116 (58.3%)

68 (34.2%)

Minimum

5 (14.7%)

7 (20.6%)

51 (25.6%)

26 (13.1%)

Intermediate

5 (14.7%)

7 (20.6%)

24 (12.1%)

31 (15.6%)

Maximum

4 (11.8%)

12 (35.3%)

8 (4%)

74 (37.2%)

MRA

0.331

None

26 (76.5%)

21 (61.8%)

135 (67.8%)

96 (48.2%)

Intermediate

3 (8.8%)

5 (14.7%)

15 (7.5%)

31 (15.6%)

Maximum

5 (14.7%)

8 (23.5%)

49 (24.6%)

72 (36.2%)