Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Am J Med. 2020 Dec;133(12):1460-1470. doi: 10.1016/j.amjmed.2020.05.030. Epub 2020 Jun 28.
Digoxin reduces the risk of heart failure hospitalization but has no effect on mortality in patients with heart failure without atrial fibrillation in the randomized controlled trial setting. Observational studies of digoxin use in patients with atrial fibrillation have suggested a higher risk for poor outcomes. Less is known about this association in patients with heart failure and atrial fibrillation, the examination of which was the objective of the current study.
We conducted an observational propensity score-matched study of predischarge digoxin initiation in 1768 hospitalized patients with heart failure and atrial fibrillation in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, balanced on 56 baseline characteristics (mean age, 79 years; 55% women; 7% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes were estimated for the 884 patients initiated on digoxin compared with 884 not initiated on digoxin.
HRs (95% CIs) for 30-day, 2-year, and 4-year all-cause mortality were 0.80 (0.55-1.18; P = .261), 0.94 (0.87-1.16; P = .936), and 1.01 (0.90-1.14; P = .729), respectively. Respective HRs (95% CIs) for heart failure readmission were 0.67 (0.49-0.92; P = .014), 0.81 (0.69-0.94; P = .005), and 0.85 (0.74-0.97; P = .022), and those for all-cause readmission were 0.78 (0.64-0.96; P = .016), 0.90 (0.81-1.00; P = .057), and 0.91 (0.83-1.01; P = .603). These associations were homogeneous between patients with left ventricular ejection fraction ≤45% vs >45%.
Among hospitalized older patients with heart failure (HFrEF and HFpEF) and atrial fibrillation, initiation of digoxin was associated with a lower risk of heart failure readmission but had no association with mortality.
在随机对照试验中，地高辛可降低心力衰竭住院风险，但对无房颤的心力衰竭患者的死亡率无影响。地高辛在房颤患者中的观察性研究表明，其预后不良的风险更高。而对于心力衰竭合并房颤患者的这一关联，人们了解较少，本研究即对此进行了考察。
我们对医疗保险相关的启动拯救生命治疗计划（OPTIMIZE-HF）登记数据库中 1768 例住院心力衰竭合并房颤患者出院前地高辛使用情况进行了一项基于倾向性评分匹配的观察性研究，根据 56 项基线特征（平均年龄 79 岁；55%为女性；7%为非裔美国人）进行了平衡。比较了 884 例接受地高辛治疗的患者与 884 例未接受地高辛治疗的患者的结局风险比（HR）和 95%置信区间（CI）。
30 天、2 年和 4 年全因死亡率的 HR（95%CI）分别为 0.80（0.55-1.18；P=0.261）、0.94（0.87-1.16；P=0.936）和 1.01（0.90-1.14；P=0.729）。心力衰竭再入院的相应 HR（95%CI）分别为 0.67（0.49-0.92；P=0.014）、0.81（0.69-0.94；P=0.005）和 0.85（0.74-0.97；P=0.022），全因再入院的相应 HR（95%CI）分别为 0.78（0.64-0.96；P=0.016）、0.90（0.81-1.00；P=0.057）和 0.91（0.83-1.01；P=0.603）。对于左心室射血分数≤45%与>45%的患者，这些关联具有同质性。
在住院的老年心力衰竭（射血分数保留性心衰和射血分数降低性心衰）合并房颤患者中，地高辛的起始治疗与心力衰竭再入院风险降低相关，与死亡率无关。
