Jones J G, Kallman H, Revicki D A
Postgrad Med. 1987 Feb 1;81(2):141-2, 145-50. doi: 10.1080/00325481.1987.11699705.
The long-term efficacy of digoxin maintenance therapy must be determined individually for patients with normal sinus rhythm who have a history of congestive heart failure but no remaining signs or symptoms. Predictive factors for successful discontinuation of the agent in the elderly include normal mental status (including absence of depression), ability to adequately perform activities of daily living, general feelings of well-being, absence of multiple organic disease, absence of multiple drug use, and no evidence of existing congestive heart failure or atrial fibrillation. Our findings indicate that physicians and patients need to reexamine the concept that congestive heart failure is necessarily a chronic disease. Certainly, evidence exists that continuing digitalis therapy indefinitely is inappropriate and may be harmful. Further investigation may prove that congestive heart failure in the elderly, like pneumonia, is a common acute occurrence and in many cases not a chronic state for which patients are destined to receive medication indefinitely. We hope that the findings from our small sample will stimulate other investigators to question the indiscriminate long-term use of digitalis in the elderly.
对于有充血性心力衰竭病史但无残余体征或症状的窦性心律正常患者，地高辛维持治疗的长期疗效必须因人而异。老年人成功停用该药物的预测因素包括精神状态正常（包括无抑郁）、有能力充分进行日常生活活动、总体感觉良好、无多种器质性疾病、无多种药物联用，且无现有充血性心力衰竭或心房颤动的证据。我们的研究结果表明，医生和患者需要重新审视充血性心力衰竭必然是一种慢性疾病这一观念。当然，有证据表明无限期持续使用洋地黄治疗是不合适的，而且可能有害。进一步的研究可能证明，老年人的充血性心力衰竭，如同肺炎一样，是一种常见的急性病症，在许多情况下并非一种患者注定要无限期接受药物治疗的慢性状态。我们希望我们小样本的研究结果将促使其他研究人员质疑在老年人中不加区分地长期使用洋地黄的做法。
