Qureshi Waqas, O'Neal Wesley T, Soliman Elsayed Z, Al-Mallah Mouaz H
Department of Internal Medicine, Division of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States.
Cardiol J. 2016;23(3):333-43. doi: 10.5603/CJ.a2016.0016. Epub 2016 Apr 11.
There is growing controversy regarding the association between digoxin and mortality in atrial fibrillation (AF). The aim of this analysis was to systematically review digoxin use and risk of mortality in patients with AF.
MEDLINE, EMBASE, GoogleScholar, CINAHL, meeting abstracts, presentations, and Cochrane central databases were searched from inception through December 2014, without language restrictions. For a study to be selected, it had to report the risk of mortality associated with digoxin use in AF patients as an outcome measure. Data were extracted by 2 independent authors. Evidence tables were created.
A total of 16 studies (6 post hoc analyses of randomized controlled trials) with 111,978 digoxin users and 389,643 non-digoxin users were included. In a random effects model, patients treated with digoxin had a 27% increased risk of all-cause mortality (pooled HR 1.27; 95% CI 1.19-1.36) and 21% increased risk of cardiovascular mortality (pooled HR 1.21; 95% CI 1.12-1.30) compared with those who did not use digoxin. In a random effects model, the association of digoxin with all-cause mortality was stronger for AF patients without heart failure (pooled HR 1.47; 95% CI 1.25-1.73) than AF patients with heart failure (pooled HR 1.21; 95% CI 1.07-1.36, interaction p = 0.06).
Digoxin use in AF is associated with increased risk of all-cause and cardiovascular mortalities. The effect size was larger for AF patients without heart failure than AF patients with heart failure. The study suggests further directed analyses to study the effect that is suggested by this meta-analysis, especially in AF without heart failure.
关于地高辛与心房颤动（AF）患者死亡率之间的关联，争议日益增多。本分析的目的是系统评价AF患者使用地高辛的情况及其死亡风险。
检索MEDLINE、EMBASE、谷歌学术、CINAHL、会议摘要、报告以及考克兰中央数据库，检索时间从建库至2014年12月，无语言限制。入选的研究必须将AF患者使用地高辛相关的死亡风险作为一项结局指标进行报告。由两名独立作者提取数据，并创建证据表。
共纳入16项研究（6项随机对照试验的事后分析），其中使用地高辛者111,978例，未使用地高辛者389,643例。在随机效应模型中，与未使用地高辛的患者相比，使用地高辛治疗的患者全因死亡风险增加27%（合并风险比1.27；95%置信区间1.19 - 1.36），心血管死亡风险增加21%（合并风险比1.21；95%置信区间1.12 - 1.30）。在随机效应模型中，对于无心力衰竭的AF患者，地高辛与全因死亡的关联比有心力衰竭的AF患者更强（合并风险比1.47；95%置信区间1.25 - 1.73），而有心力衰竭的AF患者为（合并风险比1.21；95%置信区间1.07 - 1.36，交互作用P = 0.06）。
AF患者使用地高辛与全因死亡和心血管死亡风险增加相关。无心力衰竭的AF患者的效应量大于有心力衰竭的AF患者。该研究提示需进一步进行针对性分析，以研究本荟萃分析所提示的效应，尤其是在无心力衰竭的AF患者中。
