Largely dismissed heart failure drug may help solve costly problem for Medicare and hospitals

The heart failure drug digoxin, used less and less since it “failed” in its 1997 clinical trial, may do something no drug has achieved since: reduce by 34 percent the chances that heart failure patients will be admitted to the hospital within 30 days of first taking it, according to an analysis highlighted today at the American College of Cardiology’s 62nd Annual Scientific Session and published online simultaneously in The American Journal of Medicine.

Preventing frequent admissions became a national priority last year as the Centers for Medicare and Medicaid Services (CMS) penalized thousands of hospitals an estimated total of $300 million for having above average 30-day readmission rates in patients with pneumonia, heart attack or heart failure.

CMS leveled the penalties as part of federal healthcare reform and with the rationale that many admissions and readmissions are preventable if care is handled properly. While that is a matter of debate, one in five Medicare recipients is readmitted within 30 days at an annual cost of $17 billion, with heart failure the most common culprit. Digoxin is known to reduce acute heart failure symptoms like shortness of breath, the kind of frightening experience that sends people racing to emergency rooms.

“This is the first study to suggest that any drug, old or new, can dramatically reduce the risk of 30-day, all-cause hospital admission among older heart failure patients,” said Ali Ahmed, M.D., M.P.H., professor in the divisions of Gerontology, Geriatrics, & Palliative Care  and Cardiovascular Disease within the School of Medicine at the University of Alabama at Birmingham (UAB). Ahmed today presented the work by researchers from UAB and Birmingham Veterans Affairs Medical Center as part of the ACC’s Late Breaking Clinical Trials session.

Obsessed with reducing mortality

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The current study is a re-analysis of data from the original Digitalis Investigation Group (DIG) trial, which was funded by the National Heart, Lung, and Blood Institute (NHLBI) and the Veterans Affairs Cooperative Studies program. DIG was a randomized, controlled clinical trial conducted in the early 1990s in which digoxin failed to lower the risk of death (all-cause mortality) in patients with chronic heart failure. The treatment did, however, reduce the risk for hospitalization due to worsening heart failure by 28 percent when patients were followed for three years.

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