Digoxin in advanced heart failure patients: a question of rhythm
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Outros Autores: | , , , , , , , , |
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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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 |
format |
article |
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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info:eu-repo/semantics/openAccess |
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openAccess |
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reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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