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• W4230472935 abstract "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). To determine the impact of digoxin on outcomes of advanced HF patients and to assess whether prognosis differs in patients in AF and SR. 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. 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. 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. 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). Determinar o impacto prognóstico da digoxina na IC e verificar se este é diferente consoante se encontrem em FA ou em RS. 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. 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 diferenças entre os doentes medicados e não medicados com digoxina relativamente aos parâmetros demográficos, clínicos, ecocardiográficos ou laboratoriais. 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." @default.
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• W4230472935 date "2013-04-01" @default.
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• W4230472935 title "Digoxin in advanced heart failure patients: A question of rhythm" @default.
• W4230472935 doi "https://doi.org/10.1016/j.repce.2012.11.020" @default.
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