Rengin Çetin Güvenç, Tolga Sinan Güvenç, Mert Efe Çağlar, Abdullah Ayar Al Arfaj, Ailin Behrad, Mehmet Birhan Yılmaz
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Multivariable adjustments were done and propensity scores were calculated for various prognostic indicators, including signs and symptoms of heart failure and functional capacity. Crude mortality, mortality adjusted for covariates, mortality in the propensity score-matched cohort, and Bayesian factors (BFs) were analyzed.</p><h3>Results</h3><p>Crude 1-year mortality rate did not differ between patients on and off digoxin (17.3% vs 20.1%, log-rank <i>p </i>= 0.46), and digoxin was not related to mortality following multivariable adjustment (hazard ratio 0.87, 95% confidence interval 0.539–1.402, <i>p </i>= 0.57). Similarly, all-cause mortality was similar in 220 propensity-score adjusted patients (17.3% vs 20.0%, log-rank <i>p </i>= 0.55). 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引用次数: 0
摘要
目的地高辛用于治疗心力衰竭已有数百年的历史，但这种药物在现代的作用却备受争议。尤其令人担忧的是，最近的观察结果表明，使用地高辛会增加全因死亡率，但这些观察结果存在偏差，因为这些研究通常没有对疾病的严重程度进行充分补偿。我们利用一个全国性的登记数据库，旨在研究地高辛是否与心衰患者的 1 年全因死亡率相关，而不论其表型如何。对各种预后指标（包括心衰的体征和症状以及功能能力）进行了多变量调整和倾向评分计算。结果服用和未服用地高辛的患者的 1 年粗死亡率没有差异（17.3% vs 20.1%，log-rank p = 0.46），经多变量调整后，地高辛与死亡率无关（危险比为 0.87，95% 置信区间为 0.539-1.402，p = 0.57）。同样，220 名倾向分数调整后的患者的全因死亡率也相似（17.3% vs 20.0%，log-rank p = 0.55）。在贝叶斯分析中，有中到强的证据表明，非匹配队列（BF10 0.091）与匹配队列（BF10 0.296）之间缺乏差异，而匹配队列则有弱到中等的证据。
Digoxin is Not Related to Mortality in Patients with Heart Failure: Results from the SELFIE-TR Registry
Aims
Digoxin has been used in the treatment for heart failure for centuries, but the role of this drug in the modern era is controversial. A particular concern is the recent observational findings suggesting an increase in all-cause mortality with digoxin, although such observations suffer from biased results since these studies usually do not provide adequate compensation for the severity of disease. Using a nationwide registry database, we aimed to investigate whether digoxin is associated with 1-year all-cause mortality in patients with heart failure irrespective of phenotype.
Methods
A total of 1014 out of 1054 patients in the registry, of whom 110 patients were on digoxin, were included in the study. Multivariable adjustments were done and propensity scores were calculated for various prognostic indicators, including signs and symptoms of heart failure and functional capacity. Crude mortality, mortality adjusted for covariates, mortality in the propensity score-matched cohort, and Bayesian factors (BFs) were analyzed.
Results
Crude 1-year mortality rate did not differ between patients on and off digoxin (17.3% vs 20.1%, log-rank p = 0.46), and digoxin was not related to mortality following multivariable adjustment (hazard ratio 0.87, 95% confidence interval 0.539–1.402, p = 0.57). Similarly, all-cause mortality was similar in 220 propensity-score adjusted patients (17.3% vs 20.0%, log-rank p = 0.55). On Bayesian analyses, there was moderate to strong evidence suggesting a lack of difference between in unmatched cohort (BF10 0.091) and weak-to-moderate evidence in the matched cohort (BF10 0.296).
Conclusions
In this nationwide cohort, we did not find any evidence for an increased 1-year mortality in heart failure patients on digoxin.
期刊介绍：
Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents.
Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations.
The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.
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