Digoxin Discontinuation in Patients With HFrEF on Beta-Blockers: Implication for Future 'Knock-Out Trials' in Heart Failure.

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine Pub Date : 2024-10-17 DOI:10.1016/j.amjmed.2024.10.015

Phillip H Lam, Kevin Liu, Amiya A Ahmed, Javed Butler, Paul A Heidenreich, Markus S Anker, Charles Faselis, Prakash Deedwania, Wilbert S Aronow, Ioannis Kanonidis, Ravi Masson, Gauravpal S Gill, Charity J Morgan, Cherinne Arundel, Richard M Allman, Wen-Chih Wu, Gregg C Fonarow, Ali Ahmed

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引用次数: 0

Abstract

Background: National heart failure guidelines recommend quadruple therapy with renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors for patients with heart failure with reduced ejection fraction (HFrEF), most of whom also receive loop diuretics. However, the guidelines are less clear about the safe approaches to discontinuing older drugs whose decreasing or residual benefit is less well understood. The objective of this study was to examine whether digoxin can be safely discontinued in patients with HFrEF receiving beta-blockers.

Methods: In OPTIMIZE-HF, of 2477 patients with HFrEF (EF ≤45%) receiving beta-blockers and digoxin, digoxin was discontinued in 450 patients. We assembled a propensity score-matched cohort of 433 pairs of patients in which digoxin continuation vs. discontinuation groups were balanced on 51 baseline characteristics. Using the same approach, from 992 patients not on beta-blockers, we assembled a matched cohort of 198 pairs of patients also balanced on 51 baseline characteristics. Hazard ratios (HRs) and 95% CIs for 1-year outcomes were estimated.

Results: Among patients receiving beta-blockers, digoxin discontinuation had no association with the combined endpoint of heart failure readmission or death (HR, 1.01; 95% CI, 0.85-1.19), heart failure readmission (HR, 1.03; 95% CI, 0.85-1.25) or death (HR, 0.91; 95% CI, 0.72-1.14). Respective HRs (95% CIs) among patients not receiving beta-blockers were 1.60 (1.25-2.04), 1.62 (1.18-2.22) and 1.43 (1.08-1.89).

Conclusions: Digoxin can be discontinued without increasing the risk of adverse outcomes in patients with HFrEF receiving beta-blockers. Future studies need to examine the residual benefit of older heart failure drugs to ensure their safe discontinuation in patients with HFrEF receiving newer guideline-directed medical therapy.

查看原文本刊更多论文

服用β-受体阻滞剂的心力衰竭患者停用地高辛：对未来心衰 "淘汰试验 "的启示。

背景：国家心力衰竭指南建议，射血分数降低型心力衰竭（HFrEF）患者应接受肾素-血管紧张素系统抑制剂、β-受体阻滞剂、矿皮质激素受体拮抗剂和钠-葡萄糖共转运体 2 抑制剂的四联疗法，其中大多数患者还需接受环利尿剂治疗。然而，指南对停用老药的安全方法并不十分明确，因为人们对老药的益处减少或残余益处了解较少。本研究旨在探讨接受β受体阻滞剂治疗的高房颤患者能否安全停用地高辛：在 OPTIMIZE-HF 中，2477 名接受β-受体阻滞剂和地高辛治疗的 HFrEF（EF ≤45%）患者中，450 名患者停用了地高辛。我们组建了一个由 433 对患者组成的倾向得分匹配队列，其中地高辛继续使用组与停用组在 51 个基线特征上保持平衡。采用同样的方法，我们从 992 名未使用β-受体阻滞剂的患者中筛选出了 198 对匹配队列，这 198 对患者的 51 项基线特征也达到了平衡。我们估算了一年结果的危险比（HRs）和 95% CIs：结果：在接受β受体阻滞剂治疗的患者中，停用地高辛与心衰再入院或死亡（HR，1.01；95% CI，0.85-1.19）、心衰再入院（HR，1.03；95% CI，0.85-1.25）或死亡（HR，0.91；95% CI，0.72-1.14）的合并终点无关。未接受β-受体阻滞剂治疗的患者的HR（95% CI）分别为1.60（1.25-2.04）、1.62（1.18-2.22）和1.43（1.08-1.89）：对于接受β受体阻滞剂治疗的高房颤患者来说，停用地高辛不会增加不良后果的风险。未来的研究需要检查较老心衰药物的剩余益处，以确保接受较新指南指导的药物治疗的 HFrEF 患者安全停用这些药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Medicine 医学-医学：内科

CiteScore

6.30

自引率

3.40%

发文量

449

审稿时长

9 days

期刊介绍： The American Journal of Medicine - "The Green Journal" - publishes original clinical research of interest to physicians in internal medicine, both in academia and community-based practice. AJM is the official journal of the Alliance for Academic Internal Medicine, a prestigious group comprising internal medicine department chairs at more than 125 medical schools across the U.S. Each issue carries useful reviews as well as seminal articles of immediate interest to the practicing physician, including peer-reviewed, original scientific studies that have direct clinical significance and position papers on health care issues, medical education, and public policy.