Everything old is new again, even in medicine, with a just-released study finding that an older, inexpensive drug may help keep heart failure patients out of the hospital.
Largely abandoned after a 1997 study found that it did not lower heart failure patients' death rates, a re-analysis of that data found that digoxin (also known as digitalis) may lower rates of 30-day hospital readmissions by more than one-third.
"If these findings can be replicated in contemporary older heart failure patients discharged from the hospital, digoxin may provide an inexpensive tool to reduce 30-day all-cause hospital readmissions," said study lead researcher Dr. Ali Ahmed, a professor of medicine and epidemiology in the divisions of geriatrics and cardiology at the University of Alabama at Birmingham.
Ahmed presented the findings Monday in San Francisco at the annual meeting of the American College of Cardiology (ACC); the results will be published simultaneously online in the American Journal of Medicine. His research was funded by the U.S. National Heart, Lung, and Blood Institute and the Veterans Administration.
According to the National Heart, Lung, and Blood Institute, more than 5.8 million Americans suffer from heart failure, a notoriously tough-to-treat condition in which the heart's pumping action grows gradually weaker over time.
"Heart failure is the leading reason for hospital admission and readmission for older Americans," Ahmed said. "Over a quarter of older adults hospitalized for heart failure return to the hospital within 30 days, and the majority return to the hospital for the same reasons -- heart failure symptoms."
The story he described actually began in 1997, when a trial from the Digitalis Investigation Group found that digoxin failed to reduce death rates in patients with heart failure. With newer drugs offering new treatment options, rates of use for digoxin for heart failure fell from about two-thirds of patients before the study's release to one-third afterward, according to the ACC.
But many of those treatment decisions may have been premature. In the new study, researchers re-examined data on rates of 30-day hospital readmissions among the 6,800 patients in the Digitalis Investigation Group trial, half of whom were aged 65 or older.
The team found that patients taking digoxin had 34 percent lower odds of needing to go back into hospital care within a month of discharge, compared to people not taking the drug.
That's an important finding, since estimates from the U.S. Centers for Medicare and Medicaid put the annual bill for unplanned hospital readmissions at more than $17 billion -- about one-sixth of all Medicare spending on hospitalizations.
Having to re-enter hospital care multiple times is also a potent risk factor for death or adverse outcomes in people with heart failure, experts note. According to the ACC, digoxin helps strengthen the heart's contraction, helping it to pump better.
One expert said the findings show the importance of re-examining older data.
The study "raises a very interesting possibility: that digitalis may still have a role despite improved modern therapies for heart failure," said Dr. Prediman Shah, director of the division of cardiology at Cedars Sinai Heart Institute in Los Angeles. Shah said this drug, first used more than 300 years ago, "may have an incremental benefit by improving heart failure and reducing readmission rates in patients who are otherwise well-treated."
Shah said digoxin costs mere pennies per day. If that small investment could reduce the rate of expensive hospital readmissions, that would not only help patients but also aid "hospital systems in terms of their finances," he said.
Might this new data help trigger a shift back to the widespread use of digoxin for heart failure?
"If you think about the cost of instituting digitalis as being practically negligible, people will probably be persuaded that if, for a few cents a day, you can reduce readmission by even a few percent, what is there to lose?" Shah said.