Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Spain.
Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain.
Eur J Clin Invest. 2018 Nov;48(11):e13014. doi: 10.1111/eci.13014. Epub 2018 Aug 23.
The impact of atrial fibrillation (AF) on mortality of patients with heart failure (HF) has been established. Nevertheless, the effect of some factors in mortality, such as digoxin or diuretic use, remains controversial. This study aims at assessing mortality in community-dwelling patients with stable HF related to AF and determines the relation of these drugs with prognosis.
Community-based cohort study of HF patients diagnosed between January 2010 and December 2014 attended at any one of the 279 primary healthcare centres of the Catalan Institute of Health (Spain). Follow-up ended on December 31, 2015, and the main outcome was mortality for all causes. The effect of clinical and demographic characteristics on survival was assessed by Cox proportional hazards model.
A total of 13 334 HF patients were included. Mean age was 78.7 years (SD 10.1), and 36.8% had AF. Mean follow-up was 26.9 months (SD 14.0). At the end of the study, 25.8% patients had died, and mortality was higher when AF was present (28.8% vs 24.1%, P < 0.001, respectively). Multivariate model confirmed the higher risk of death for AF patients (HR 1.10 95%, CI 1.02-1.19). Digoxin and diuretics were not associated with higher mortality in AF patients (HR 1.04 95% CI 0.92-1.18 and HR 1.04 95% CI 0.85-1.26, respectively).
An excess of mortality in HF patients with AF was found in a large retrospective community-based cohort. Digoxin and diuretics did not affect mortality in HF patients with AF.
心房颤动（AF）对心力衰竭（HF）患者死亡率的影响已得到证实。然而，一些因素对死亡率的影响，如地高辛或利尿剂的使用，仍然存在争议。本研究旨在评估与 AF 相关的稳定 HF 社区患者的死亡率，并确定这些药物与预后的关系。
这是一项基于社区的 HF 患者队列研究，纳入了 2010 年 1 月至 2014 年 12 月间在西班牙加泰罗尼亚卫生研究所的 279 个基层医疗中心之一就诊的 HF 患者。随访于 2015 年 12 月 31 日结束，主要结局是全因死亡率。采用 Cox 比例风险模型评估临床和人口统计学特征对生存的影响。
共纳入 13334 例 HF 患者，平均年龄为 78.7 岁（标准差 10.1），36.8%有 AF。平均随访时间为 26.9 个月（标准差 14.0）。研究结束时，25.8%的患者死亡，AF 患者的死亡率更高（分别为 28.8%和 24.1%，P<0.001）。多变量模型证实 AF 患者死亡风险较高（HR 1.10，95%CI 1.02-1.19）。地高辛和利尿剂与 AF 患者的死亡率升高无关（HR 1.04，95%CI 0.92-1.18 和 HR 1.04，95%CI 0.85-1.26）。
在一项大型回顾性基于社区的队列研究中，发现 AF 合并 HF 患者的死亡率过高。地高辛和利尿剂并未影响 AF 合并 HF 患者的死亡率。
