Wu Shuang, Yang Yan-Min, Zhu Jun, Ren Jia-Meng, Wang Juan, Zhang Han, Shao Xing-Hui
Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China.
Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China.
Am J Emerg Med. 2017 Nov;35(11):1589-1594. doi: 10.1016/j.ajem.2017.04.070. Epub 2017 Apr 27.
The aim of this study was to evaluate factors of digoxin use and its relation to mortality in ED patients with atrial fibrillation (AF).
The Chinese AF registry enrolled 2016 AF patients from 20 representative EDs, and the period of study was one year. Predictors of digoxin use and its relation to mortality were assessed by logistic and Cox regression analyses.
Digoxin was assigned in 609 patients (30.6%), and younger age, lower body mass index values, and existence of permanent AF, heart failure (HF), chronic obstructive pulmonary disease, and valvular heart disease were identified to be factors associated with digoxin use. During the follow-up, compared to patients without digoxin therapy, digoxin-treated patients had significantly higher risk of all-cause death (17.2% vs. 13.0%, P=0.012) and cardiovascular death (15.1% vs. 6.7%, P<0.001), but similar risk of sudden cardiac death (1.1% vs. 0.7%, P=0.341). However, after adjustment for related covariates, digoxin use was no longer notably associated with increased all-cause mortality (hazards ratio [HR] 0.973, 95% confidence interval [CI] 0.718-1.318) and cardiovascular death (HR 1.313, 95% CI 0.905-1.906). Besides, neutral associations of digoxin treatment to mortality were obtained in relevant subgroups, with no interactions observed between digoxin and gender, HF, valvular heart disease, or concomitant warfarin treatment in mortality risk.
In ED patients with AF, digoxin was more frequently assigned to vulnerable patients with concomitant HF or valvular heart disease, and digoxin use was not related to a significantly increased risk of mortality.
本研究旨在评估急诊房颤（AF）患者使用地高辛的因素及其与死亡率的关系。
中国房颤登记研究纳入了来自20家代表性急诊科的2016例房颤患者，研究为期一年。通过逻辑回归和Cox回归分析评估地高辛使用的预测因素及其与死亡率的关系。
609例患者（30.6%）使用了地高辛，年龄较小、体重指数较低、永久性房颤、心力衰竭（HF）、慢性阻塞性肺疾病和瓣膜性心脏病的存在被确定为与地高辛使用相关的因素。在随访期间，与未接受地高辛治疗的患者相比，接受地高辛治疗的患者全因死亡风险显著更高（17.2%对13.0%，P = 0.012）和心血管死亡风险显著更高（15.1%对6.7%，P < 0.001），但心源性猝死风险相似（1.1%对0.7%，P = 0.341）。然而，在调整相关协变量后，地高辛的使用与全因死亡率增加（风险比[HR] 0.973，95%置信区间[CI] 0.718 - 1.318）和心血管死亡（HR 1.313，95% CI 0.905 - 1.906）不再显著相关。此外，在相关亚组中获得了地高辛治疗与死亡率的中性关联，在地高辛与性别、HF、瓣膜性心脏病或同时使用华法林治疗的死亡率风险之间未观察到相互作用。
在急诊房颤患者中，地高辛更常用于伴有HF或瓣膜性心脏病的脆弱患者，且地高辛的使用与死亡率显著增加无关。
