Increased mortality associated with digoxin in contemporary patients with atrial fibrillation: findings from the TREAT-AF study.
Increased mortality associated with digoxin in contemporary patients with atrial fibrillation: findings from the TREAT-AF study.
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DOI：
10.1016/j.jacc.2014.03.060
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发表时间：
2014-08-19
影响因子：
24
通讯作者：
Heidenreich, Paul A.
中科院分区：
文献类型：
--
作者：
Turakhia, Mintu P.;Santangeli, Pasquale;Winkelmayer, Wolfgang C.;Xu, Xiangyan;Ullal, Aditya J.;Than, Claire T.;Schmitt, Susan;Holmes, Tyson H.;Frayne, Susan M.;Phibbs, Ciaran S.;Yang, Felix;Hoang, Donald D.;Ho, P. Michael;Heidenreich, Paul A.
评价地高辛与房颤死亡率的关系。尽管地高辛在临床实践指南中得到认可，但关于其在房颤和扑动（AF）中的安全性的数据有限。使用来自美国退伍军人管理局（VA）医疗保健系统的完整数据，我们确定了2004-2008年退伍军人管理局财政年度在门诊就诊90天内新诊断的非瓣膜性房颤患者。我们使用多变量和倾向匹配的Cox比例风险来评估地高辛使用与死亡的关系。通过敏感性分析评估残留混杂。在122465例患者中，随访353168人年（年龄72.1±10.3岁，98.4%为男性），28679例（23.4%）患者接受地高辛治疗。地高辛治疗组的累积死亡率高于未治疗组（每1000人年95 vs 67； P<0.001）。经多因素调整（HR: 1.26, 95%CI: 1.23-1.29， P<0.001）和倾向匹配（HR: 1.21, 95%CI: 1.17-1.25， P<0.001）后，地高辛的使用与死亡率独立相关，即使在药物依从性调整后也是如此。死亡风险不受年龄、性别、心力衰竭、肾功能或同时使用受体阻滞剂、胺碘酮或华法林的影响。地高辛与新诊断房颤患者死亡风险增加相关，与药物依从性、肾功能、心血管合并症和伴随治疗无关。这些发现挑战了目前心血管学会关于在房颤中使用地高辛的建议。
To evaluate the association of digoxin with mortality in atrial fibrillation. Despite endorsement of digoxin in clinical practice guidelines, there exist limited data on its safety in atrial fibrillation and flutter (AF). Using complete data from the US Department of Veterans Administration (VA) Health Care System, we identified patients with newly-diagnosed, non-valvular AF seen within 90 days in an outpatient setting between VA fiscal years 2004-2008. We used multivariate and propensity-matched Cox proportional hazards to evaluate the association of digoxin use to death. Residual confounding was assessed by sensitivity analysis. Of 122,465 patients with 353,168 person-years of follow-up (age 72.1±10.3 years, 98.4% males), 28,679 (23.4%) patients received digoxin. Cumulative mortality rates were higher for digoxin-treated patients than for untreated patients (95 vs. 67 per 1,000 person-years; P<0.001). Digoxin use was independently associated with mortality after multivariate adjustment (HR: 1.26, 95%CI: 1.23-1.29, P<0.001) and propensity matching (HR: 1.21, 95%CI: 1.17-1.25, P<0.001), even after adjustment for drug adherence. The risk of death was not modified by age, sex, heart failure, kidney function, or concomitant use of beta blockers, amiodarone, or warfarin. Digoxin was associated with increased risk of death in patients with newly-diagnosed AF, independent of drug adherence, kidney function, cardiovascular comorbidities, and concomitant therapies. These findings challenge current cardiovascular society recommendations on use of digoxin in AF.
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影响因子：
3.3
作者：
Sohn MW;Arnold N;Maynard C;Hynes DM
通讯作者：
Hynes DM
影响因子：
3
作者：
STEINER, JF;KOEPSELL, TD;INUI, TS
通讯作者：
INUI, TS
影响因子：
2.5
作者：
Smith, MW;Joseph, GJ
通讯作者：
Joseph, GJ
影响因子：
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作者：
Fang, MC;Stafford, RS;Singer, DE
通讯作者：
Singer, DE
影响因子：
37.8
作者：
Corley, SD;Epstein, AE;Wyse, DG
通讯作者：
Wyse, DG