Freeman James V, Yang Jingrong, Sung Sue Hee, Hlatky Mark A, Go Alan S
Departments of Medicine.
Circ Cardiovasc Qual Outcomes. 2013 Sep 1;6(5):525-33. doi: 10.1161/CIRCOUTCOMES.111.000079. Epub 2013 Sep 10.
Clinical guidelines recommend digoxin for patients with symptomatic systolic heart failure (HF) receiving optimal medical therapy, but this recommendation is based on limited, older trial data. We evaluated the effectiveness and safety of digoxin in a contemporary cohort of patients with incident systolic HF.
We identified adults with incident systolic HF between 2006 and 2008 within Kaiser Permanente Northern California who had no prior digoxin use. We used multivariable extended Cox regression to examine the association between new digoxin use and risks of death and HF hospitalization, controlling for medical history, laboratory results, medications, HF disease severity, and the propensity for digoxin use. We also conducted analyses stratified by sex and concurrent β-blocker use. Among 2891 newly diagnosed patients with systolic HF, 529 (18%) received digoxin. During a median 2.5 years of follow-up, incident digoxin use was associated with higher rates of death (14.2 versus 11.3 per 100 person-years) and HF hospitalization (28.2 versus 24.4 per 100 person-years). In multivariable analysis, incident digoxin use was associated with higher mortality (hazard ratio, 1.72; 95% confidence interval, 1.25-2.36) but no significant difference in the risk of HF hospitalization (hazard ratio, 1.05; 95% confidence interval, 0.82-1.34). Results were similar in analyses stratified by sex and β-blocker use.
Digoxin use in patients with incident systolic HF was independently associated with a higher risk of death but no difference in HF hospitalization.
临床指南推荐，对于接受最佳药物治疗的有症状收缩性心力衰竭（HF）患者使用地高辛，但这一推荐基于有限的、年代较久的试验数据。我们评估了地高辛在当代初发收缩性HF患者队列中的有效性和安全性。
我们在北加利福尼亚凯撒医疗集团中确定了2006年至2008年间初发收缩性HF且之前未使用过地高辛的成年人。我们使用多变量扩展Cox回归来研究新用地高辛与死亡风险和HF住院风险之间的关联，同时控制病史、实验室检查结果、用药情况、HF疾病严重程度以及使用地高辛的倾向。我们还按性别和同时使用β受体阻滞剂进行了分层分析。在2891例新诊断的收缩性HF患者中，529例（18%）接受了地高辛治疗。在中位2.5年的随访期间，初用地高辛与更高的死亡率（每100人年14.2例对11.3例）和HF住院率（每100人年28.2例对24.4例）相关。在多变量分析中，初用地高辛与更高的死亡率相关（风险比，1.72；95%置信区间，1.25 - 2.36），但在HF住院风险方面无显著差异（风险比，1.05；95%置信区间，0.82 - 1.34）。按性别和β受体阻滞剂使用情况分层分析的结果相似。
初发收缩性HF患者使用地高辛与更高的死亡风险独立相关，但在HF住院方面无差异。
