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CAE:地高辛增加心房颤动患者死亡风险

来源:生物谷 2014-11-25 15:54

2014年11月25日 讯 /生物谷BIOON/ --近日,一篇发表在国际杂志Circulation: Arrhythmia and Electrophysiology上的研究论文中,来自美国凯萨医疗机构(Kaiser Permanente)的研究人员通过研究发现,一种常用于治疗心脏疾病的药物地高辛或可使得诊断为心房颤动的成年个体死亡风险增加71%,入院风险增加63%。

地高辛是一种来源于洋地黄的药物,其用于进行心房颤动病人心率控制的治疗已经长达一个多世纪了;当前用于心房颤动管理的临床实践指导准则中推荐地高辛用于静坐个体静息心率的控制。研究者Anthony Steimle博士表示,我们的研究揭示了地高辛的使用在治疗心房颤动上或许应当被重新评估,如果给予其它的方法用于进行心率控制,那么地高辛在临床上用于治疗心房颤动时或许需要谨慎使用,尤其是在缺少收缩性心力衰竭症状的时候。

文章中,研究人员在2006年1月1日至2009年6月30日间对新诊断为心房颤动的超过1.5万名患者进行研究,这些患者之前并无心力衰竭情况及地高辛使用记录;研究人员检测了地高辛的使用和患者死亡及入院风险之间的独立性关联。

在研究过程中,17.8%的参与者开始服用地高辛,在整个研究组中有1140名个体发生了死亡,相比非地高辛使用组来讲,地高辛使用组个体的死亡风险较高(8.3% vs 4.9%);与此同时有8456名个体出现了入院治疗的情况,而且接受地高辛治疗的个体入院的比率比不接受治疗的患者的比率要高(60.1% vs 37.2%)。研究者Alan S. Go说道,地高辛常用于维持心房颤动患者的心率控制,但是支持这种说法的数据非常有限;大多数小型、古老的临床研究并没有评估地高辛对患者死亡率和入院率的长期影响。

最后研究人员说道,这项研究基于前期的大量工作之上而进行,我们认为本文研究对于临床上进行决策制定具有非常重要的价值,其可以帮助临床医生决定地高辛的使用是否可以影响患者的健康。(生物谷Bioon.com)

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Digoxin and Risk of Death in Adults with Atrial Fibrillation: The ATRIA-CVRN Study

James V. Freeman1, Kristi Reynolds2, Margaret Fang3, Natalia Udaltsova4, Anthony Steimle5, Niela K. Pomernacki4, Leila H. Borowsky6, Teresa N. Harrison2, Daniel E. Singer7 and Alan S. Go8*

Background—Digoxin remains commonly used for rate control in atrial fibrillation, but very limited data exist supporting this practice and some studies have shown an association with adverse outcomes. We examined the independent association between digoxin and risks of death and hospitalization in adults with incident atrial fibrillation and no heart failure. Methods and Results—We performed a retrospective cohort study of 14,787 age, gender and high-dimensional propensity score-matched adults with incident atrial fibrillation and no prior heart failure or digoxin use in the AnTicoagulation and Risk factors In Atrial fibrillation-Cardiovascular Research Network (ATRIA-CVRN) Study within Kaiser Permanente Northern and Southern California. We examined the independent association between newly initiated digoxin and the risks of death and hospitalization using extended Cox regression. During a median 1.17 (interquartile range 0.49-1.97) years of follow-up among matched patients with atrial fibrillation, incident digoxin use was associated with higher rates of death (8.3 vs. 4.9 per 100 person-years, P<0.001) and hospitalization (60.1 vs. 37.2 per 100 person-years, P<0.001). Incident digoxin use was independently associated with a 71% higher risk of death (hazard ratio [HR] 1.71, 95%CI:1.52-1.93) and a 63% higher risk of hospitalization (HR 1.63, 95%CI:1.56-1.71). Results were consistent in subgroups of age and gender and when using "intent-to-treat" or "on-treatment" analytic approaches. Conclusions—In adults with atrial fibrillation, digoxin use was independently associated with higher risks of death and hospitalization. Given other available rate control options, digoxin should be used with caution in the management of atrial fibrillation.

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