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BACKGROUND Digoxin reduces the risk of heart failure hospitalization in patients with heart failure with reduced ejection fraction (HFrEF). Less is known about this association in patients with heart failure with preserved ejection fraction (HFpEF), the examination of which was the objective of the current study. METHODS In the Medicare-linked OPTIMIZE-HF registry, 7374 patients hospitalized for HF had ejection fraction ≥50% who were not receiving digoxin before admission. Of these, 5675 had a heart rate ≥50 beats/minute, an estimated