Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada; Division of Internal Medicine, McGill University Health Center, Montreal, Quebec, Canada.
Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.
Am J Cardiol. 2014 Aug 1;114(3):401-6. doi: 10.1016/j.amjcard.2014.05.013. Epub 2014 May 16.
Previous studies on digoxin use in patients with atrial fibrillation (AF) and the risk of all-cause mortality found conflicting results. We conducted a population-based, retrospective, cohort study of patients aged ≥65 years admitted to a hospital with a primary or secondary diagnosis of AF, in Quebec province, Canada, from 1998 to 2012. The AF cohort was grouped into patients with and without heart failure (HF) and into digoxin and no-digoxin users according to the first prescription filled for digoxin within 30 days after AF hospital discharge. We derived propensity score-matched digoxin and no-digoxin treatment groups for the groups of patients with and without HF, respectively, and conducted multivariable Cox proportional hazards regression analyses to determine association between digoxin use and all-cause mortality. The AF propensity score-matched cohorts of patients with and without HF were well balanced on baseline characteristics. In the propensity score-matched HF group, digoxin use was associated with a 14% greater risk of all-cause mortality (adjusted hazard ratio 1.14, 95% confidence interval 1.10 to 1.17). In the propensity score-matched no-HF group, digoxin use was associated with a 17% greater risk of all-cause mortality (adjusted hazard ratio 1.17, 95% confidence interval 1.14 to 1.19). In conclusion, our retrospective analyses found that digoxin use was associated with a greater risk for all-cause mortality in patients aged ≥65 years with AF regardless of concomitant HF. Large, multicenter, randomized controlled trials or prospective cohort studies are required to clarify this issue.
先前关于心房颤动 (AF) 患者地高辛使用与全因死亡率风险的研究结果存在矛盾。我们在加拿大魁北克省进行了一项基于人群的回顾性队列研究，纳入了 1998 年至 2012 年期间因 AF 住院的年龄≥65 岁的患者。将 AF 队列根据 AF 出院后 30 天内首次开出的地高辛处方分为有或无心力衰竭 (HF) 组，并分为地高辛组和非地高辛组。分别为有和无 HF 的患者组导出倾向评分匹配的地高辛和非地高辛治疗组，并进行多变量 Cox 比例风险回归分析，以确定地高辛使用与全因死亡率之间的关联。有和无 HF 的 AF 倾向评分匹配队列在基线特征上很好地平衡。在地高辛组中，HF 患者使用地高辛与全因死亡率增加 14%相关（调整后的危险比 1.14，95%置信区间 1.10 至 1.17）。在地高辛组中，HF 患者使用地高辛与全因死亡率增加 17%相关（调整后的危险比 1.17，95%置信区间 1.14 至 1.19）。总之，我们的回顾性分析发现，无论是否伴有 HF，年龄≥65 岁的 AF 患者使用地高辛与全因死亡率风险增加相关。需要进行大型、多中心、随机对照试验或前瞻性队列研究来阐明这个问题。
