Digoxin effect in mortality associated to right ventricular dysfunction in patients with pulmonary hypertension

Background and Introduction: the use of digoxin in the treatment of pulmonary arterial hypertension is limited. Some studies show slight increases in cardiac output, but others do not find any benefit on survival. Purpose: to determine if the use of digoxin in pulmonary arterial hypertension in patients with right ventricular dysfunction is associated with a reduction in mortality. Methods: this was a retrospective cohort study of patients who attended our department between 1984 and 2016. Survival analysis was made with Kaplan Meier curves and significance with logarithmic range test. Multivariate analysis was based on Cox proportional hazard model. Results: a total of 275 patients with a diagnosis of pulmonary arterial hypertension were analyzed. Monotherapy (63.66%) was predominantly with sildenafil in 40.36% (111 patients) followed by digoxin in 75 patients (24%). There was a follow up of 37 years. Mean survival was 24.27 years (IC: 14.7-26.9), with a total of 64 deaths. The use of digoxin did not showed any benefit on survival. Mortality rate was 44.6 deaths /1000 patients without significant statistics (Log-Rank, p = 0.08 and Wilcoxon, p = 0.08) even in patients with heart failure (p = 0.87) Conclusions: there is no benefit on survival with the long term use of digoxin, except for rehospitalization and functional class.