Digoxin and prognosis of heart failure in older patients with preserved ejection fraction: Importance of heart rate. Results from an observational and multicenter study
Por:
Llacer, P, Nunez, J, Bayes-Genis, A, Martel, AC, Hernandez, YC, Manglano, JD, Rocha, PA, Rangel, LS, Del Olmo, VG, Manzano, L and Perez-Barquero, MM
Publicada:
1 feb 2019
Ahead of Print:
22 oct 2018
Categoría:
Internal medicine
Resumen:
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.
Filiaciones:
Llacer, P:
Hosp Manises, Dept Internal Med, Ave Generalitat Valenciana 50, Valencia 46940, Spain
Nunez, J:
Univ Valencia, Hosp Clin Univ, Dept Cardiol, INCLIVA, Valencia, Spain
CIBER Cardiovasc, Madrid, Spain
:
CIBER Cardiovasc, Madrid, Spain
Hosp Badalona Germans Trias & Pujol, Inst Heart, Badalona, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona, Spain
Martel, AC:
Hosp Univ Gran Canaria Dr Negrin, Dept Internal Med, Las Palmas Gran Canaria, Spain
Hernandez, YC:
Consorcio Hosp Gen Univ Valencia, Dept Internal Med, Valencia, Spain
Manglano, JD:
Hosp Univ Miguel Servet, Dept Internal Med, Zaragoza, Spain
Rocha, PA:
Hosp Clin Dr Manuel Quintela, Internal Med & Cardiol Dept, Montevideo, Uruguay
Rangel, LS:
Hosp Univ Infanta Sofia, Dept Internal Med, Madrid, Spain
Del Olmo, VG:
Univ Alcala IRYCIS, Hosp Univ Ramon y Cajal, Dept Internal Med, Madrid, Spain
Manzano, L:
Univ Alcala IRYCIS, Hosp Univ Ramon y Cajal, Dept Internal Med, Madrid, Spain
Perez-Barquero, MM:
Univ Cordoba, Dept Internal Med, IMIBIC, Hosp Univ Reina Sofia, Cordoba, Spain
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