Abstract

The aim was to determine the benefit of betablockers and/or digoxin on mortality in heart failure in black Africans using a comparative study. This was a prospective, non-interventional, comparative, four-arm follow-up cohort study using the Abidjan Heart Institute database. Patients were divided into four arms: betablocker alone, betablocker plus digoxin, digoxin alone, and a control group with conventional treatment without betablocker or digoxin followed for 2 years. The four groups compared were initially comparable for sociodemographic data for a total follow-up of 730.5 days, including 37 deaths at the end of this study (5.70%). In multivariate analysis, after adjustment, treatment with betablocker alone (RR 0.77, p=0.62) or combined with digoxin compared with control (RR 1.13, p=0.84) was not significantly associated with death, nor was treatment with betablocker vs non-betablocker (RR 0.58, p=0.14). On the other hand, treatment with digoxin alone compared with control (RR 3.13, p=0.0388) was significantly associated with death. Male sex, high natraemia and use of anticoagulants were the necessary factors for mortality in the digoxin group. Compared with betablockers, digoxin does not appear to have a beneficial effect on mortality in black African patients with heart failure. However, these patients on digoxin appear to be more severe. These results could be confirmed by a large, long-term study of black subjects.

Key words: Clinical trial, betablocker, digoxin, heart failure, Africa, mortality.