Digoxin Discontinuation and Outcomes inPatients With HeartFailure With Reduced EjectionFractionJACCResearch ArticleAug 06, : 74 (5), 10.1016/j.jacc..05.064本文由“天纳”临床学术信息人工智能系统自动翻译Central Illustration
BackgroundThe deleterious effects of discontinuation of digoxin on outcomes in ambulatory patients with chronic heart failure (HF) with reduced ejection fraction (HFrEF) receiving angiotensin-converting enzyme inhibitors are well-documented.停用地高辛对接受血管紧张素转换酶抑制剂降低射血分数（hfrf）的慢性心力衰竭（hf）门诊患者预后的有害影响已被充分记录。ObjectivesThe authors sought to determine the relationship between digoxin discontinuation and outcomes in hospitalized patients with HFrEF receiving more contemporary guideline-directed medical therapies including beta-blockers and mineralocorticoid receptor antagonists.作者试图确定地高辛停药与接受更现代指导性药物治疗（包括β受体阻滞剂和盐皮质激素受体拮抗剂）的HFREF住院患者结局之间的关系。MethodsOf the 11,900 hospitalized patients with HFrEF (EF≤45%) in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with HeartFailure) registry, 3,499 received pre-admission digoxin, which was discontinued in 721 patients. Using propensity scores for digoxin discontinuation, estimated for each of the 3,499 patients, a matched cohort of 698 pairs of patients, balanced on 50 baseline characteristics (mean age 76 years; mean EF 28%; 41% women; 13% African American; 65% on beta-blockers) was assembled.在医疗保险连锁优化-HF（有组织的心脏衰竭住院患者救生计划）登记册中的11900名HFRef（ef≤45%）住院患者中，3499名患者接受了入院前地高辛治疗，721名患者停止使用。使用每3499名患者的地高辛停药倾向评分，对698对患者进行配对队列研究，平衡50个基线特征（平均年龄76岁；平均EF 28%；41%女性；13%非洲裔美国人；65%β受体阻滞剂）。ResultsFour-year post-discharge, digoxin discontinuation was associated with significantly higher risks of HF readmission (hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 1.05 to 1.39; p=0.007), all-cause readmission (HR: 1.16; 95%CI: 1.04 to 1.31; p=0.010), and the combined endpoint of HF readmission or all-cause mortality (HR: 1.20; 95%CI: 1.07 to 1.34; p=0.002), but not all-cause mortality (HR: 1.09; 95%CI: 0.97 to 1.24; p=0.163). Discontinuation of digoxin was associated with a significantly higher risk of all 4 outcomes at 6months and 1 year post-discharge. At 30days, digoxin discontinuation was associated with higher risks of all-cause mortality (HR: 1.80; 95%CI: 1.26 to 2.57; p=0.001) and the combined endpoint (HR: 1.36; 95%CI: 1.09 to 1.71; p=0.007), but not of HF readmission (HR: 1.19; 95%CI: 0.90 to 1.59; p=0.226) or all-cause readmission (HR: 1.03; 95%CI: 0.84 to 1.26; p=0.778).出院后4年，地高辛停药与心衰再入院的风险显着增加相关（风险比[HR]1.21；95%置信区间[CI]1.05-1.39；P 0.007）、全因再入院（HR:1.16；95%CI:1.04-1.31；P 0.010）和H的联合终点。F再入院或全因死亡率（HR:1.20；95%CI:1.07至1.34；P 0.002），但不是全因死亡率（HR:1.09；95%CI:0.97至1.24；P 0.163）。停用地高辛与出院后6个月和1年的所有4种结局的风险显着较高相关。在30天时，地高辛停药与全因死亡率（HR:1.80；95%CI:1.26至2.57；P 0.001）和联合终点（HR:1.36；95%CI:1.09至1.71；P 0.007）的较高风险相关，但与心力衰竭再入院（HR:1.19；95%CI:0.90至1.59；P 0.226）或全因死亡率无关。再入院（HR:1.03；95%CI:0.84至1.26；P=0.778）。ConclusionsAmong hospitalized older patients with HFrEF on more contemporary guideline-directed medical therapies, discontinuation of pre-admission digoxin therapy was associated with poor outcomes.在接受更现代指导性医疗治疗的住院老年HFREF患者中，停止入院前地高辛治疗与不良预后相关。FootnotesThe content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs. Dr. Ahmed was supported in part by the National Institutes of Health through grants R01-HL085561, R01-HL085561-S, and R01-HL097047 from the National Heart, Lung, and Blood Institute. The OPTIMIZE-HF registry was sponsored by GlaxoSmithKline, but played no role in the design, conduct, analyses, or interpretation of the current study. Dr. Packer has served as a consultant for Abbvie, Akcea, Amgen, AstraZeneca, Boehringer Ingelheim, Bayer, Cardiorentis, Daiichi-Sankyo, Gilead, NovoNordisk, Pfizer, Relypsa, Sanofi, and Theravance. Dr. Pitt has been a consultant to Bayer, Sanofi, AstraZeneca, KBP Pharmaceuticals, scPharmaceuticals, Sarfez, Relypsa/Vifor, and Cereno Scientific; has stock options in KBP Pharmaceuticals, Relypsda, and Sarfez; and holds U.S. patent # 9931412 for site-specific delivery of eplerenone to the myocardium. 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JACCResearch ArticleAug 06, : 74 (5), 10.1016/j.jacc..05.064
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