Digoxin Initiation and Outcomes in Patients with Heart Failure (HFrEF and HFpEF) and Atrial Fibrillation
Autor: | Charity J. Morgan, Hans Moore, Markus S. Anker, Cherinne Arundel, Prakash Deedwania, Richard M. Allman, Samuel Wopperer, Steven N. Singh, Charles Faselis, Gregg C. Fonarow, Qing Zeng, Phillip H. Lam, Lakshmi Tummala, Pamela Karasik, Ali Ahmed |
---|---|
Rok vydání: | 2020 |
Předmět: |
Male
Digoxin medicine.medical_specialty Cardiotonic Agents 030204 cardiovascular system & hematology Lower risk law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine Atrial Fibrillation medicine Humans 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over Heart Failure Ejection fraction business.industry Hazard ratio Atrial fibrillation General Medicine medicine.disease Confidence interval Treatment Outcome Heart failure Cardiology Female business medicine.drug |
Zdroj: | The American Journal of Medicine. 133:1460-1470 |
ISSN: | 0002-9343 |
Popis: | Background 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. Methods 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. Results 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%. Conclusions 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. |
Databáze: | OpenAIRE |
Externí odkaz: |