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Chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality

OBJECTIVES: Digitalis therapy (digoxin or digitoxin) in patients with heart failure is subject to an ongoing debate. Recent data suggest an increased mortality in patients receiving digitalis. This study investigated the effects of chronic digitalis therapy prior to heart transplantation (HTX) on po...

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Autores principales: Rivinius, Rasmus, Helmschrott, Matthias, Ruhparwar, Arjang, Rahm, Ann-Kathrin, Darche, Fabrice F, Thomas, Dierk, Bruckner, Tom, Ehlermann, Philipp, Katus, Hugo A, Doesch, Andreas O
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648316/
https://www.ncbi.nlm.nih.gov/pubmed/29075124
http://dx.doi.org/10.2147/TCRM.S147062
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author Rivinius, Rasmus
Helmschrott, Matthias
Ruhparwar, Arjang
Rahm, Ann-Kathrin
Darche, Fabrice F
Thomas, Dierk
Bruckner, Tom
Ehlermann, Philipp
Katus, Hugo A
Doesch, Andreas O
author_facet Rivinius, Rasmus
Helmschrott, Matthias
Ruhparwar, Arjang
Rahm, Ann-Kathrin
Darche, Fabrice F
Thomas, Dierk
Bruckner, Tom
Ehlermann, Philipp
Katus, Hugo A
Doesch, Andreas O
author_sort Rivinius, Rasmus
collection PubMed
description OBJECTIVES: Digitalis therapy (digoxin or digitoxin) in patients with heart failure is subject to an ongoing debate. Recent data suggest an increased mortality in patients receiving digitalis. This study investigated the effects of chronic digitalis therapy prior to heart transplantation (HTX) on posttransplant outcomes. PATIENTS AND METHODS: This was a retrospective, observational, single-center study. It comprised 530 adult patients who were heart-transplanted at Heidelberg University Hospital between 1989 and 2012. Patients with digitalis prior to HTX (≥3 months) were compared to those without (no or <3 months of digitalis). Patients with digitalis were further subdivided into patients receiving digoxin or digitoxin. Primary outcomes were early posttransplant atrial fibrillation and mortality. RESULTS: A total of 347 patients (65.5%) had digitalis before HTX. Of these, 180 received digoxin (51.9%) and 167 received digitoxin (48.1%). Patients with digitalis before HTX had a significantly lower 30-day (P=0.0148) and 2-year (P=0.0473) survival. There was no significant difference between digoxin and digitoxin in 30-day (P=0.9466) or 2-year (P=0.0723) survival. Multivariate analysis for posttransplant 30-day mortality showed pretransplant digitalis therapy as an independent risk factor (hazard ratio =2.097, CI: 1.036–4.248, P=0.0397). Regarding atrial fibrillation in the early posttransplant period, there was neither a statistically significant difference between patients with and without digitalis (P=0.1327) nor between patients with digoxin or digitoxin (P=0.5867). CONCLUSION: Digitalis in patients before HTX is an independent risk factor for increased posttransplant mortality.
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spelling pubmed-56483162017-10-26 Chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality Rivinius, Rasmus Helmschrott, Matthias Ruhparwar, Arjang Rahm, Ann-Kathrin Darche, Fabrice F Thomas, Dierk Bruckner, Tom Ehlermann, Philipp Katus, Hugo A Doesch, Andreas O Ther Clin Risk Manag Original Research OBJECTIVES: Digitalis therapy (digoxin or digitoxin) in patients with heart failure is subject to an ongoing debate. Recent data suggest an increased mortality in patients receiving digitalis. This study investigated the effects of chronic digitalis therapy prior to heart transplantation (HTX) on posttransplant outcomes. PATIENTS AND METHODS: This was a retrospective, observational, single-center study. It comprised 530 adult patients who were heart-transplanted at Heidelberg University Hospital between 1989 and 2012. Patients with digitalis prior to HTX (≥3 months) were compared to those without (no or <3 months of digitalis). Patients with digitalis were further subdivided into patients receiving digoxin or digitoxin. Primary outcomes were early posttransplant atrial fibrillation and mortality. RESULTS: A total of 347 patients (65.5%) had digitalis before HTX. Of these, 180 received digoxin (51.9%) and 167 received digitoxin (48.1%). Patients with digitalis before HTX had a significantly lower 30-day (P=0.0148) and 2-year (P=0.0473) survival. There was no significant difference between digoxin and digitoxin in 30-day (P=0.9466) or 2-year (P=0.0723) survival. Multivariate analysis for posttransplant 30-day mortality showed pretransplant digitalis therapy as an independent risk factor (hazard ratio =2.097, CI: 1.036–4.248, P=0.0397). Regarding atrial fibrillation in the early posttransplant period, there was neither a statistically significant difference between patients with and without digitalis (P=0.1327) nor between patients with digoxin or digitoxin (P=0.5867). CONCLUSION: Digitalis in patients before HTX is an independent risk factor for increased posttransplant mortality. Dove Medical Press 2017-10-13 /pmc/articles/PMC5648316/ /pubmed/29075124 http://dx.doi.org/10.2147/TCRM.S147062 Text en © 2017 Rivinius et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Rivinius, Rasmus
Helmschrott, Matthias
Ruhparwar, Arjang
Rahm, Ann-Kathrin
Darche, Fabrice F
Thomas, Dierk
Bruckner, Tom
Ehlermann, Philipp
Katus, Hugo A
Doesch, Andreas O
Chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality
title Chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality
title_full Chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality
title_fullStr Chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality
title_full_unstemmed Chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality
title_short Chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality
title_sort chronic digitalis therapy in patients before heart transplantation is an independent risk factor for increased posttransplant mortality
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648316/
https://www.ncbi.nlm.nih.gov/pubmed/29075124
http://dx.doi.org/10.2147/TCRM.S147062
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