Temporal Trends of Digoxin Use in Patients Hospitalized With Heart Failure Analysis From the American Heart Association Get With The Guidelines-Heart Failure Registry
Temporal Trends of Digoxin Use in Patients Hospitalized With Heart Failure Analysis From the American Heart Association Get With The Guidelines-Heart Failure Registry
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DOI：
10.1016/j.jchf.2015.12.003
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发表时间：
2016-05-01
影响因子：
13
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Patel, Nish;Ju, Christine;Fonarow, Gregg C.
目的 本研究的目的是评估因心力衰竭 (HF) 入院的患者出院时与地高辛使用相关的时间趋势和因素。 背景技术 在美国，地高辛具有用于治疗射血分数降低 (HFrEF) 的 HF 的 IIa 级推荐。美国目前临床实践中地高辛的使用、时间趋势和心力衰竭患者的临床特征尚未得到充分研究。 方法 对 2005 年 1 月至 2014 年 6 月期间参与 Get With TheGuidelines-HF 登记的 398 家医院的 255,901 名心力衰竭住院患者（117,761 名 HFrEF 和 138,140 名保留 EF [HFpEF]）进行观察分析，以评估与地高辛使用相关的时间趋势和因素。结果 在 117,761 名 HFrEF 患者中，只有 19.7% 的患者在出院时接受了地高辛治疗。地高辛处方从 2005 年的 33.1% 下降到 2014 年的 10.7%（P 趋势 < 0.0001）。与 HFrEF 中使用地高辛相关的因素包括心房 P 趋势颤动 (AF)（比值比 [OR]：2.14；95% 置信区间 [CI]：2.02 至 2.28）、植入式心律转复除颤器使用史（OR：1.39；95% CI：1.32 至 1.46）、慢性阻塞性肺疾病（OR： 1.13, 95% CI: 1.08 至 1.18)、糖尿病 (OR: 1.10, 95% CI: 1.06 至 1.14)、年龄较小 (OR: 0.96, 95% CI: 0.95 至 0.97)、血压降低 (OR: 0.96, 95% CI: 0.96 至0.97），并且无肾功能不全病史（OR：0.91，95％CI：0.85至0.97）。 2005 年，不伴 AF 的 HFpEF 患者 (n = 138,140) 中地高辛的使用率为 9.8%，2014 年下降至 2.2%（P 趋势 < 0.0001）。 结论 每 5 名 HFrEF 患者中就有 1 人在出院时接受地高辛治疗，在研究期间使用量呈显着下降趋势。无 AF 的 HFpEF 患者中地高辛的使用量非常低，并且在研究期间有所减少。 (C) 2016 年，美国心脏病学会基金会。
OBJECTIVES The aim of this study was to assess temporal trends and factors associated with digoxin use at discharge among patients admitted with heart failure (HF).BACKGROUND Digoxin has class Ila recommendations for treating HF with reduced ejection fraction (HFrEF) in the United States. Digoxin use, temporal trends, and clinical characteristics of HF patients in current clinical practice in the United States have not been well studied.METHODS An observational analysis of 255,901 patients hospitalized with HF (117,761 with HFrEF and 138,140 with preserved EF [HFpEF]) from 398 hospitals participating in the Get With The Guidelines-HF registry between January 2005 and June 2014 was conducted to assess the temporal trends and factors associated with digoxin use.RESULTS Among 117,761 HFrEF patients, only 19.7% received digoxin at discharge. Digoxin prescriptions decreased from 33.1% in 2005 to 10.7% in 2014 (P-trend < 0.0001). Factors associated with digoxin use in HFrEF included atrial P-trend fibrillation (AF) (odds ratio [OR]: 2.14; 95% confidence intervals [CI]: 2.02 to 2.28), history of implantable cardioverter defibrillator use (OR: 1.39; 95% CI: 1.32 to 1.46), chronic obstructive pulmonary disease (OR: 1.13, 95% CI: 1.08 to 1.18), diabetes mellitus (OR: 1.10, 95% CI: 1.06 to 1.14), younger age (OR: 0.96, 95% CI: 0.95 to 0.97), lower blood pressure (OR: 0.96, 95% CI: 0.96 to 0.97), and having no history of renal insufficiency (OR: 0.91, 95% CI: 0.85 to 0.97). Use of digoxin in patients with HFpEF (n = 138,140) without AF was 9.8% in 2005, which decreased to 2.2% in 2014 (P-trend < 0.0001).CONCLUSIONS One in 5 HFrEF patients received digoxin at discharge, with a significant downward temporal trend in use over the study period. Use of digoxin in HFpEF patients without AF was very low and decreased over the study period. (C) 2016 by the American College of Cardiology Foundation.