Digoxin in advanced heart failure patients: a question of rhythm

Detalhes bibliográficos
Autor(a) principal: Jorge, Elisabete
Data de Publicação: 2013
Outros Autores: Baptista, Rui, Martins, Hélia, Saraiva, Fátima, Costa, Susana, Vieira, Henrique, Coelho, Lourenço, Monteiro, Pedro, Franco, Fátima, Providência, Luís A.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10316/102704
https://doi.org/10.1016/j.repc.2012.11.007
Resumo: Background: The impact of digoxin on outcomes of patients with advanced heart failure (HF) remains uncertain and its effect may be different for patients in atrial fibrillation (AF) or sinus rhythm (SR). Objectives: To determine the impact of digoxin on outcomes of advanced HF patients and to assess whether prognosis differs in patients in AF and SR. Methods: A total of 268 consecutive patients admitted to an intensive care unit with decompensated HF were evaluated. Patients were divided into two groups: A --- patients with AF (n=89), and B --- patients in SR (n=179). For each group we compared patients medicated and not medicated with digoxin. A mean follow-up of 3.3 years was performed. Results: Addition of digoxin to contemporary standard HF therapy showed no impact on mortality of patients in group B (all-cause mortality in follow-up: 19.1% vs. 22.5%, p=0.788). Regarding group A, we observed significantly lower medium-term mortality for patients on digoxin therapy (18.6% vs. 46.6%, p=0.048). Digoxin therapy did not influence readmissions for decompensated HF. Among AF patients, no differences were found regarding demographic, clinical, echocardiographic and laboratory variables between patients medicated and not medicated with digoxin. Conclusions: Digoxin therapy may improve the prognosis of advanced HF patients with AF under optimal medical therapy. However, no benefit of digoxin was demonstrated for patients in SR. These results may help to improve patient selection for digoxin therapy.
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spelling Digoxin in advanced heart failure patients: a question of rhythmAdvanced heart failureDigoxinAtrial fibrillationPrognosisInsuficiência cardíaca avançadaDigoxinaFibrilhação auricularPrognósticoAtrial FibrillationCardiotonic AgentsDigoxinFemaleHeart FailureHumansMaleMiddle AgedPrognosisRetrospective StudiesSeverity of Illness IndexBackground: The impact of digoxin on outcomes of patients with advanced heart failure (HF) remains uncertain and its effect may be different for patients in atrial fibrillation (AF) or sinus rhythm (SR). Objectives: To determine the impact of digoxin on outcomes of advanced HF patients and to assess whether prognosis differs in patients in AF and SR. Methods: A total of 268 consecutive patients admitted to an intensive care unit with decompensated HF were evaluated. Patients were divided into two groups: A --- patients with AF (n=89), and B --- patients in SR (n=179). For each group we compared patients medicated and not medicated with digoxin. A mean follow-up of 3.3 years was performed. Results: Addition of digoxin to contemporary standard HF therapy showed no impact on mortality of patients in group B (all-cause mortality in follow-up: 19.1% vs. 22.5%, p=0.788). Regarding group A, we observed significantly lower medium-term mortality for patients on digoxin therapy (18.6% vs. 46.6%, p=0.048). Digoxin therapy did not influence readmissions for decompensated HF. Among AF patients, no differences were found regarding demographic, clinical, echocardiographic and laboratory variables between patients medicated and not medicated with digoxin. Conclusions: Digoxin therapy may improve the prognosis of advanced HF patients with AF under optimal medical therapy. However, no benefit of digoxin was demonstrated for patients in SR. These results may help to improve patient selection for digoxin therapy.Introdução: O impacto prognóstico da digoxina na insuficiência cardíaca (IC) avançada permanece mal esclarecido. A relevância da terapêutica digitálica pode ser diferente na fibrilhação auricular (FA) relativamente ao ritmo sinusal (RS). Objectivos: Determinar o impacto prognóstico da digoxina na IC e verificar se este é diferente consoante se encontrem em FA ou em RS. Métodos: Estudaram-se 268 doentes internados numa unidade de cuidados intensivos por IC descompensada. Dividiu-se a população em dois grupos: A --- 89 doentes em FA; grupo B --- 179 doentes em RS. Para cada grupo compararam-se os doentes medicados com os não medicados com digoxina. Realizou-se um seguimento clínico com a duração mediana de 3,3 anos. Resultados: A digoxina não teve impacto na mortalidade dos doentes com IC avançada que se encontravam em RS (mortalidade a 3,3 anos: 19,1% versus 22,5%, p = 0,788), adicionada à terapêutica médica otimizada. Nos doentes em FA observou-se uma redução significativa da mortalidade nos doentes medicados com digoxina (18,6% versus 46,6%, p = 0,048). A digoxina não alterou a taxa de reinternamentos por IC descompensada. No grupo A não se verificaram diferenc¸as entre os doentes medicados e não medicados com digoxina relativamente aos parâmetros demográficos, clínicos, ecocardiográficos ou laboratoriais. Conclusão: Este estudo sugere que a digoxina pode melhorar o prognóstico dos doentes com IC avançada e FA, sob terapêutica médica optimizada. Contudo, esta não demonstrou benefício nos doentes em RS. Estes resultados podem contribuir para uma melhor seleção dos doentes a medicar com digoxina, otimizando a relação risco/benefício desta terapêutica.2013-04info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/102704http://hdl.handle.net/10316/102704https://doi.org/10.1016/j.repc.2012.11.007eng08702551Jorge, ElisabeteBaptista, RuiMartins, HéliaSaraiva, FátimaCosta, SusanaVieira, HenriqueCoelho, LourençoMonteiro, PedroFranco, FátimaProvidência, Luís A.info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2022-10-07T20:31:24Zoai:estudogeral.uc.pt:10316/102704Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:19:38.601811Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Digoxin in advanced heart failure patients: a question of rhythm
title Digoxin in advanced heart failure patients: a question of rhythm
spellingShingle Digoxin in advanced heart failure patients: a question of rhythm
Jorge, Elisabete
Advanced heart failure
Digoxin
Atrial fibrillation
Prognosis
Insuficiência cardíaca avançada
Digoxina
Fibrilhação auricular
Prognóstico
Atrial Fibrillation
Cardiotonic Agents
Digoxin
Female
Heart Failure
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Severity of Illness Index
title_short Digoxin in advanced heart failure patients: a question of rhythm
title_full Digoxin in advanced heart failure patients: a question of rhythm
title_fullStr Digoxin in advanced heart failure patients: a question of rhythm
title_full_unstemmed Digoxin in advanced heart failure patients: a question of rhythm
title_sort Digoxin in advanced heart failure patients: a question of rhythm
author Jorge, Elisabete
author_facet Jorge, Elisabete
Baptista, Rui
Martins, Hélia
Saraiva, Fátima
Costa, Susana
Vieira, Henrique
Coelho, Lourenço
Monteiro, Pedro
Franco, Fátima
Providência, Luís A.
author_role author
author2 Baptista, Rui
Martins, Hélia
Saraiva, Fátima
Costa, Susana
Vieira, Henrique
Coelho, Lourenço
Monteiro, Pedro
Franco, Fátima
Providência, Luís A.
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Jorge, Elisabete
Baptista, Rui
Martins, Hélia
Saraiva, Fátima
Costa, Susana
Vieira, Henrique
Coelho, Lourenço
Monteiro, Pedro
Franco, Fátima
Providência, Luís A.
dc.subject.por.fl_str_mv Advanced heart failure
Digoxin
Atrial fibrillation
Prognosis
Insuficiência cardíaca avançada
Digoxina
Fibrilhação auricular
Prognóstico
Atrial Fibrillation
Cardiotonic Agents
Digoxin
Female
Heart Failure
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Severity of Illness Index
topic Advanced heart failure
Digoxin
Atrial fibrillation
Prognosis
Insuficiência cardíaca avançada
Digoxina
Fibrilhação auricular
Prognóstico
Atrial Fibrillation
Cardiotonic Agents
Digoxin
Female
Heart Failure
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Severity of Illness Index
description Background: The impact of digoxin on outcomes of patients with advanced heart failure (HF) remains uncertain and its effect may be different for patients in atrial fibrillation (AF) or sinus rhythm (SR). Objectives: To determine the impact of digoxin on outcomes of advanced HF patients and to assess whether prognosis differs in patients in AF and SR. Methods: A total of 268 consecutive patients admitted to an intensive care unit with decompensated HF were evaluated. Patients were divided into two groups: A --- patients with AF (n=89), and B --- patients in SR (n=179). For each group we compared patients medicated and not medicated with digoxin. A mean follow-up of 3.3 years was performed. Results: Addition of digoxin to contemporary standard HF therapy showed no impact on mortality of patients in group B (all-cause mortality in follow-up: 19.1% vs. 22.5%, p=0.788). Regarding group A, we observed significantly lower medium-term mortality for patients on digoxin therapy (18.6% vs. 46.6%, p=0.048). Digoxin therapy did not influence readmissions for decompensated HF. Among AF patients, no differences were found regarding demographic, clinical, echocardiographic and laboratory variables between patients medicated and not medicated with digoxin. Conclusions: Digoxin therapy may improve the prognosis of advanced HF patients with AF under optimal medical therapy. However, no benefit of digoxin was demonstrated for patients in SR. These results may help to improve patient selection for digoxin therapy.
publishDate 2013
dc.date.none.fl_str_mv 2013-04
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10316/102704
http://hdl.handle.net/10316/102704
https://doi.org/10.1016/j.repc.2012.11.007
url http://hdl.handle.net/10316/102704
https://doi.org/10.1016/j.repc.2012.11.007
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 08702551
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collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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