Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Eur Heart J Cardiovasc Pharmacother. 2022 Jun 8;8(4):372-382. doi: 10.1093/ehjcvp/pvab076.
The safety of digoxin therapy in atrial fibrillation (AF) remains ill-defined. We aimed to evaluate the effects of digoxin over beta-blocker therapy in AF.
Patients with AF who were treated with either digoxin or a beta blocker from the ESC-EHRA EORP AF (European Society of Cardiology-European Heart Rhythm Association EURObservational Research Programme Atrial Fibrillation) General Long-Term Registry were included. Outcomes of interest were all-cause mortality, cardiovascular (CV) mortality, non-CV mortality, quality of life, and number of patients with unplanned hospitalizations. Of 6377 patients, 549 (8.6%) were treated with digoxin. Over 24 months, there were 550 (8.6%) all-cause mortality events and 1304 (23.6%) patients with unplanned emergency hospitalizations. Compared to beta blocker, digoxin therapy was associated with increased all-cause mortality [hazard ratio (HR) 1.90 (95% confidence interval, CI, 1.48-2.44)], CV mortality [HR 2.18 (95% CI 1.47-3.21)], and non-CV mortality [HR 1.68 (95% CI 1.02-2.75)] with reduced quality of life [health utility score 0.555 (±0.406) vs. 0.705 (±0.346), P < 0.001] but no differences in emergency hospitalizations [HR 1.00 (95% CI 0.56-1.80)] or AF-related hospitalizations [HR 0.95 (95% CI 0.60-1.52)]. On multivariable analysis, there were no differences in any of the outcomes between both groups, after accounting for potential confounders. Similar results were obtained in the subgroups of patients with permanent AF and coexisting heart failure. There were no differences in outcomes between AF patients receiving digoxin with and without chronic kidney disease.
Poor outcomes related to the use of digoxin over beta-blocker therapy in terms of excess mortality and reduced quality of life are associated with the presence of other risk factors rather than digoxin per se. The choice of digoxin or beta-blocker therapy had no influence on the incidence of unplanned hospitalizations.
地高辛治疗心房颤动（AF）的安全性仍不明确。本研究旨在评估地高辛对比β受体阻滞剂治疗 AF 的效果。
入选 ESC-EHRA EORP AF（欧洲心脏病学会-欧洲心律协会 EURObservational Research Programme Atrial Fibrillation）一般长期注册研究中使用地高辛或β受体阻滞剂治疗的 AF 患者。主要终点为全因死亡率、心血管死亡率、非心血管死亡率、生活质量和计划外住院人数。在 6377 例患者中，549 例（8.6%）接受地高辛治疗。24 个月期间，共有 550 例（8.6%）发生全因死亡事件和 1304 例（23.6%）计划外紧急住院。与β受体阻滞剂相比，地高辛治疗与全因死亡率增加相关[风险比（HR）1.90（95%置信区间，CI，1.48-2.44）]、心血管死亡率增加[HR 2.18（95%CI 1.47-3.21）]和非心血管死亡率增加[HR 1.68（95%CI 1.02-2.75）]，生活质量降低[健康效用评分 0.555（±0.406）比 0.705（±0.346），P<0.001]，但计划外住院率无差异[HR 1.00（95%CI 0.56-1.80）]或 AF 相关住院率[HR 0.95（95%CI 0.60-1.52）]。多变量分析显示，在考虑潜在混杂因素后，两组间的任何结局均无差异。在永久性 AF 和并存心力衰竭的亚组中，也得到了相似的结果。在有或没有慢性肾病的 AF 患者中，地高辛与β受体阻滞剂治疗的结局差异无统计学意义。
与β受体阻滞剂相比，地高辛治疗导致死亡率增加和生活质量降低，与其他危险因素相关，而非地高辛本身。地高辛和β受体阻滞剂治疗选择对地高辛计划外住院发生率无影响。
