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Prognostic impact of digoxin use in a heart failure population
Session:
CO 08 - Insuficiência cardíaca crónica
Speaker:
Ana Rita Teixeira
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Rita Teixeira ; João Ferreira Reis; António Valentim Gonçalves; Pedro Brás; Rita Ilhão Moreira; Tiago Pereira da Silva; Ana Timóteo; Rui m. Soares; Bárbara Teixeira; Sofia Jacinto; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Aim:</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Digoxin (D) may be considered in patients (pts) in sinus rhythm with symptomatic HFrEF to reduce the risk of hospitalization and in pts with HFrEF and atrial fibrillation (AF) for rate control. There are some controversies regarding its safety in this population, with some studies suggesting a higher risk of events, while others showed no deleterious effect on mortality.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Methods</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Prospective evaluation of adult pts with HFrEF submitted to CPET in a tertiary centre. Pts were followed up for at least 1 year for the primary endpoints of cardiac death, urgent heart transplantation/ventricular assist device implantation in the first year of follow-up (MH1) and sudden cardiac death (SCD). Univariate followed by Cox multivariate regression analysis were performed to evaluate the impact of D use in the study’s endpoints. Survival analysis was performed using Kaplan-Meier plots.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Results</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">CPET was performed in 487 HRrEF pts, with a mean age of 56.3 ± 12.5 years, of which 79.1% were male, 46.3% of ischemic aetiology (IA), with a mean LVEF of 30.4 ± 7.6%, a mean heart failure survival score (HFSS) of 8.6±1.1. At baseline, 134 (29.3%) pts were receiving D. These pts presented lower LVEF (26.7% vs 30.9%, p<0.001), HFSS (8.3 vs 8.7, p<0.001) and sodium values (137.0 vs 138.3, p<0.001), a lower prevalence of coronary artery disease (38.8% vs 49.2%, p=0.042), but a higher prevalence of AF (38.8% vs 19.8%, p<0.001). There was no difference regarding patient’s age, prevalence of chronic kidney disease (CKD), peak oxygen uptake (pVO2) or VE/VCO2 slope values. Baseline D use was independently associated with an increased risk of SCD in our population (HR: 3.45; 95%CI 1.28-9.27, 0.014), aswell as in pts of IA (HR: 4.45, 95%CI 1.25-15.83, p=0.014) and with CKD (HR: 15.57, 95%CI 1.97-123.02, p=0.009). There was no association with SCD in pts of non-ischemic aetiology, preserved renal function and AF. Pts taking D presented a significantly higher incidence of SCD (log rank p<0.001). D use was not independently associated with MH1 in the general population (p=0.122 in multivariate analysis), but it was in pts of IA (HR: 4,94, 95%CI 1.32-18.39, p=0.017).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Conclusion</span></span></span></strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">In our HF population, D use was an independent predictor of SCD, particularly in pts with coronary artery disease and CKD.</span></span></span></span></p>
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