Digoxin is Associated with Higher Quality of Life in LVAD Recipients.
Kiernan MS, Couper G, DeNofrio D, Cowger J, and Jorde U. Digoxin is Associated with Higher Quality of Life in LVAD Recipients. J Heart Lung Transplant 2019; 38(4 Suppl):S441.
J Heart Lung Transplant
Purpose: To examine the effects of digoxin on functional capacity and quality of life as measured by the 6-minute walk test (6MWT) and Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ) in patients receiving the Heartware HVAD system. Methods: HVAD patients who remained alive on device support at 6 months from the ADVANCE + CAP, ENDURANCE + Supplemental trials were eligible. Pts were separated by digoxin use: those who were discharged from the index hospitalization on digoxin and remained on digoxin through 6 months (DIG, n=161) and those discharged from the index hospitalization not on digoxin and remained off through 6 months (NO DIG, n=533). Differences in 6MWT and KCCQ were compared between groups at baseline, 6, and 12 months. Adverse events were compared between groups from baseline through 6 months. Results: Baseline characteristics were similar: Mean age was 59 years and 23% of patients were female. Serum creatinine was 0.9mg/dL ± 0.7. History of atrial fibrillation was more common in the DIG group (57.8% vs 42.9%, p = 0.001). Compared to the NO DIG group, the DIG group had greater improvements in KCCQ score at 6 months (+ 36.8 vs. + 27.7, p=0.0001) and at 12 months (+35.9 vs +29.5, p=0.01). 6MWT was similar between groups (Table 1). Device malfunction within 6 months was more common in the DIG group [18% (0.42 EPPY) vs 9.2% (0.21 EPPY), p = 0.002]. Rates of other adverse events including 6-month re-hospitalization [47.8% (2.21 EPPY) vs 42.9% (1.8 EPPY), p=0.10] were similar. Conclusion: LVAD recipients maintained on chronic digoxin for at least 6 mo had greater improvements in QOL scores compared to those not treated with digoxin despite having higher rates of device malfunction and similar improvements in functional capacity. Prospective study is warranted.