Digoxin and prognosis of heart failure in older patients with preserved ejection fraction: Importance of heart rate. Results from an observational and multicenter study
| Autor: | Yolanda Cabanes Hernández, Manuel Montero Pérez-Barquero, Llanos Soler Rangel, Antoni Bayes-Genis, Jesús Díez Manglano, Alicia Conde Martel, Pau Llàcer, Vicente Gómez del Olmo, Pablo Álvarez Rocha, Julio Núñez, Luis Manzano |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Digoxin medicine.medical_specialty Cardiotonic Agents 030204 cardiovascular system & hematology Patient Readmission 03 medical and health sciences 0302 clinical medicine Older patients Heart Rate Risk Factors Cause of Death Internal medicine Atrial Fibrillation Heart rate Internal Medicine medicine Humans Prospective Studies Registries 030212 general & internal medicine Aged Proportional Hazards Models Aged 80 and over Heart Failure Ejection fraction Proportional hazards model business.industry Stroke Volume Atrial fibrillation Prognosis medicine.disease Patient Discharge Spain Heart failure Multivariate Analysis Cardiology Female Observational study business medicine.drug |
| Zdroj: | European Journal of Internal Medicine. 60:18-23 |
| ISSN: | 0953-6205 |
| DOI: | 10.1016/j.ejim.2018.10.010 |
| Popis: | Background The value of digoxin in heart failure (HF) remains controversial, particularly in patients with preserved ejection fraction (HFpEF). This study evaluated the 1-year risk of events after digoxin treatment for acute heart failure (AHF) in patients >70 years old with HFpEF. Methods 1833 patients were included in this analysis (mean age, 82 years). The main endpoints were all-cause death and the composite of death and/or HF re-admission within 1 year. Cox regression analysis was used to evaluate the association between digoxin treatment and prognosis. Results 401 patients received digoxin treatment; of these, 86% had atrial fibrillation. The mean baseline heart rate was 86 ± 22 bpm. At the 1-year follow-up, 375 patients (20.5%) died and 684 (37.3%) presented composite endpoints. Patients treated with digoxin showed higher rates of death (3.21 vs. 2.44 per 10 person-years, p = .019) and composite endpoint (6.72 vs. 5.18 per 10 person-years, p = .003). After multivariate adjustment, digoxin treatment remained associated with increased risks of death (HR = 1.46, 95% CI: 1.16–1.85, p = .001) and the composite endpoint (HR = 1.35, 95% CI: 1.13–1.61, p = .001). A distinctive prognostic effect of digoxin was found across the heart rate continuum; the risks for both endpoints were higher at lower heart rates and neutral at higher heart rates (p of the interactions = 0.007 and 0.03, respectively). Conclusions In older patients with HFpEF discharged after AHF, digoxin treatment was associated with increased mortality and/or re-admission, particularly in patients with lower heart rates. |
| Databáze: | OpenAIRE |
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