Digoxin Initiation and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction.
Digoxin Initiation and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction.
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DOI：
10.1016/j.amjmed.2020.02.040
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发表时间：
2020-10
影响因子：
5.9
通讯作者：
Ahmed, Ali
中科院分区：
文献类型：
--
作者：
Lam, Phillip H.;Packer, Milton;Gill, Gauravpal S.;Wu, Wen-Chih;Levy, Wayne C.;Zile, Michael R.;Brar, Vijaywant;Arundel, Cherinne;Cheng, Yan;Singh, Steven N.;Allman, Richard M.;Fonarow, Gregg C.;Ahmed, Ali
地高辛可降低射血分数降低（HFrEF）心力衰竭患者的心力衰竭住院风险。对于射血分数保留的心力衰竭（HFpEF）患者的这种相关性知之甚少，目前研究的目的是检查HFpEF。在与Medicare相关的OPTIMIZE-HF登记研究中，7374例因HF住院且入院前未接受地高辛治疗的射血分数≥50%的患者。其中，5675例患者的心率≥50次/分钟，估计肾小球滤过率（eGFR）≥30 mL/min/1.73 m2或未接受住院透析，其中524例患者开始使用地高辛。使用对5675例患者计算的地高辛开始治疗的倾向评分，我们将513对开始和未开始地高辛治疗的患者组成一个匹配队列，在58个基线特征（平均年龄80岁; 66%女性; 8%非裔美国人）上保持平衡。在匹配队列中估计与地高辛开始治疗相关的结局的风险比（HR）和95%置信区间（CI）。在1026例匹配的HFpEF患者中，分别有6%和9%的患者在开始和未开始地高辛治疗时发生30天心力衰竭再入院（HR，0.70; 95% CI，0.45-1.10; p=0.124）。与地高辛开始治疗相关的30天全因再入院和全因死亡率的HR（95% CI）分别为0.95（0.73-1.23; p=0.689）和0.93（0.55-1.56; p=0.773）。地高辛治疗开始与6年结局无关。出院前开始地高辛治疗与老年HFpEF住院患者的30天或6年结局无关。
Digoxin reduces the risk of heart failure hospitalization in patients with heart failure with reduced ejection fraction (HFrEF). Less is known about this association in patients with heart failure with preserved ejection fraction (HFpEF), the examination of which was the objective of the current study. In the Medicare-linked OPTIMIZE-HF registry, 7374 patients hospitalized for HF had ejection fraction ≥50% who were not receiving digoxin before admission. Of these, 5675 had a heart rate ≥50 beats/minute, an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2 or did not receive inpatient dialysis, and digoxin was initiated in 524 of these patients. Using propensity scores for digoxin initiation, calculated for each of the 5675 patients, we assembled a matched cohort of 513 pairs of patients initiated and not initiated on digoxin, balanced on 58 baseline characteristics (mean age, 80 years; 66% women; 8% African American). Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin initiation were estimated in the matched cohort. Among the 1026 matched patients with HFpEF, 30-day heart failure readmission occurred in 6% and 9% of patients initiated and not initiated on digoxin, respectively (HR, 0.70; 95% CI, 0.45–1.10; p=0.124). HRs (95% CIs) for 30-day all-cause readmission and all-cause mortality associated with digoxin initiation were 0.95 (0.73–1.23; p=0.689) and 0.93 (0.55–1.56; p=0.773), respectively. Digoxin initiation had no association with 6-year outcomes. Digoxin initiation before hospital discharge was not associated with 30-day or 6-year outcomes in older hospitalized patients with HFpEF.
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影响因子：
5.9
作者：
Ahmed, Ali;Fonarow, Gregg C.;Zhang, Yan;Sanders, Paul W.;Allman, Richard M.;Arnett, Donna K.;Feller, Margaret A.;Love, Thomas E.;Aban, Inmaculada B.;Levesque, Raynald;Ekundayo, O. James;Dell'Italia, Louis J.;Bakris, George L.;Rich, Michael W.
通讯作者：
Rich, Michael W.
影响因子：
4.6
作者：
Bavishi, Chirag;Chatterjee, Saurav;Messerli, Franz H.
通讯作者：
Messerli, Franz H.
影响因子：
5.9
作者：
Ahmed, Ali;Bourge, Robert C.;Allman, Richard M.
通讯作者：
Allman, Richard M.
影响因子：
5.9
作者：
COVIT, AB;SCHAER, GL;CODY, RJ
通讯作者：
CODY, RJ
影响因子：
120.7
作者：
Kitzman, DW;Little, WC;Stewart, KP
通讯作者：
Stewart, KP