Ahmed Ali, Gambassi Giovanni, Weaver Michael T, Young James B, Wehrmacher William H, Rich Michael W
University of Alabama at Birmingham, Birmingham, Alabama, USA.
Am J Cardiol. 2007 Jul 15;100(2):280-4. doi: 10.1016/j.amjcard.2007.02.099. Epub 2007 Jun 6.
Discontinuation of digoxin is associated with worsening heart failure (HF) symptoms. However, the long-term effects of discontinuation of digoxin therapy on mortality and morbidity in HF have not been well studied. Of the 7,788 participants in the Digoxin Investigation Group trial, 3,365 received digoxin before randomization. During the trial, digoxin was continued in 1,666 patients and discontinued in 1,699 patients. Using multivariable Cox regression analyses, we first determined the effect of discontinuation of digoxin on mortality and hospitalization during 39.7 months of median follow-up. Of the 1,666 patients continued on digoxin, 457 had low (0.5 to 0.9 ng/ml) and 340 had high (>or=1.0 ng/ml) serum digoxin concentrations (SDC) after 1 month of therapy and of the 1,699 patients whose digoxin was discontinued, 1,674 were alive at 1 month. We examined the effects of continuation of digoxin at low or high SDC. Compared with continuation of long-term digoxin therapy, discontinuation of digoxin was associated with a significant increase in all-cause hospitalization (adjusted hazard ratio [AHR] 1.18, 95% confidence interval [CI] 1.09 to 1.28, p <0.0001) and HF hospitalization (AHR 1.35, 95% CI 1.20 to 1.51, p <0.0001), but had no effect on all-cause mortality (AHR 1.06, 95% CI 0.95 to 1.19, p = 0.272). In contrast, continuation of digoxin at low SDC was associated with a reduction in all-cause mortality (AHR 0.75, 95% CI 0.63 to 0.90, p = 0.002), all-cause hospitalization (AHR 0.80, 95% CI 0.70 to 0.91, p = 0.001), and hospitalization for HF (AHR 0.60, 95% CI 0.50 to 0.73, p <0.0001). In conclusion, continuation of long-term digoxin therapy at low SDC was associated with reduction in mortality and hospitalization in ambulatory patients with chronic HF receiving background therapy with angiotensin-converting enzyme inhibitors and diuretics.
停用洋地黄与心力衰竭（HF）症状恶化相关。然而，停用洋地黄治疗对HF患者死亡率和发病率的长期影响尚未得到充分研究。在洋地黄调查组试验的7788名参与者中，3365人在随机分组前接受了洋地黄治疗。在试验期间，1666例患者继续使用洋地黄，1699例患者停用洋地黄。通过多变量Cox回归分析，我们首先确定了在中位随访39.7个月期间停用洋地黄对死亡率和住院率的影响。在1666例继续使用洋地黄的患者中，457例在治疗1个月后血清洋地黄浓度（SDC）较低（0.5至0.9 ng/ml），340例较高（≥1.0 ng/ml）；在1699例停用洋地黄的患者中，1674例在1个月时存活。我们研究了低或高SDC时继续使用洋地黄的影响。与长期使用洋地黄治疗相比，停用洋地黄与全因住院率显著增加相关（调整后风险比[AHR]1.18，95%置信区间[CI]1.09至1.28，p<0.0001）和HF住院率增加相关（AHR 1.35，95%CI 1.20至1.51，p<0.0001），但对全因死亡率无影响（AHR 1.06，95%CI 0.95至1.19，p = 0.272）。相比之下，低SDC时继续使用洋地黄与全因死亡率降低相关（AHR 0.75，95%CI 0.63至0.90，p = 0.002）、全因住院率降低相关（AHR 0.80，95%CI 0.70至0.91，p = 0.001）以及HF住院率降低相关（AHR 0.60，95%CI 0.50至0.73，p<0.0001）。总之，在接受血管紧张素转换酶抑制剂和利尿剂背景治疗的慢性HF门诊患者中，低SDC时长期使用洋地黄治疗与死亡率和住院率降低相关。
