The Use of Digoxin in Patients With Worsening Chronic Heart Failure Reconsidering an Old Drug to Reduce Hospital Admissions
The Use of Digoxin in Patients With Worsening Chronic Heart Failure Reconsidering an Old Drug to Reduce Hospital Admissions
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DOI：
10.1016/j.jacc.2014.01.051
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发表时间：
2014-05-13
影响因子：
24
通讯作者：
Gheorghiade, Mihai
中科院分区：
文献类型：
--
作者：
Ambrosy, Andrew P.;Butler, Javed;Gheorghiade, Mihai
地高辛是目前仍在使用的最古老的心脏药物，但其在心力衰竭（HF）患者治疗中的作用仍存在争议。地高辛是一种从毛地黄植物中提取的纯化心脏糖苷，能增加射血分数，增加心输出量，降低肺毛细血管楔压，而不会引起心率的有害增加或血压的降低。此外，它也是一种低剂量的神经激素调节剂。在关键的DIG（地黄研究组）试验中，地高辛治疗被证明可以减少全因和hf特异性住院，但对生存没有影响。随着神经激素阻滞剂能够降低心力衰竭患者的死亡率并降低射血分数，DIG试验的结果被认为是中性的，地高辛的使用急剧下降。尽管现代药物和器械治疗显著提高了心衰门诊患者的生存率，但慢性心衰恶化患者的预后在过去20年中基本保持不变，慢性心衰恶化的定义是在标准治疗下体征和症状恶化，通常导致计划外的门诊或急诊就诊或住院。现有的数据表明，地高辛的治疗试验可能适用于仍有症状的恶化的慢性心力衰竭患者。(C) 2014年由美国心脏病学会基金会发布
Digoxin is the oldest cardiac drug still in contemporary use, yet its role in the management of patients with heart failure (HF) remains controversial. A purified cardiac glycoside derived from the foxglove plant, digoxin increases ejection fraction, augments cardiac output, and reduces pulmonary capillary wedge pressure without causing deleterious increases in heart rate or decreases in blood pressure. Moreover, it is also a neurohormonal modulator at low doses. In the pivotal DIG (Digitalis Investigation Group) trial, digoxin therapy was shown to reduce all-cause and HF-specific hospitalizations but had no effect on survival. With the discovery of neurohormonal blockers capable of reducing mortality in HF with reduced ejection fraction, the results of the DIG trial were viewed as neutral, and the use of digoxin declined precipitously. Although modern drug and device-based therapies have dramatically improved the survival of ambulatory patients with HF, outcomes for patients with worsening chronic HF, defined as deteriorating signs and symptoms on standard therapy often leading to unscheduled clinic or emergency department visits or hospitalization, have largely remained unchanged over the past 2 decades. The available data suggest that a therapeutic trial of digoxin may be appropriate in patients with worsening chronic heart failure who remain symptomatic. (C) 2014 by the American College of Cardiology Foundation