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Vol. 223. Issue 9.
Pages 532-541 (November 2023)
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Vol. 223. Issue 9.
Pages 532-541 (November 2023)
Original article
Factors associated with unjustified chronic treatment with digoxin in patients with acute heart failure and relationship with short-term prognosis
Factores asociados a tratamiento crónico no justificado con digoxina en pacientes con insuficiencia cardiaca aguda y relación con el pronóstico a corto plazo
E. Martín-Mojarroa,h, V. Gilb,h, P. Llorensc,h, S. Flores-Quesadaa,h, O.J. Troiano-Ungerera,h, A. Alquézar-Arbéd,h, J. Jacobe,h, P. Herrerof,h, C. Sánchezg,h, Ò. Mirób,h,
Corresponding author
omiro@clinic.cat

Corresponding author.
, ICA SEMES researchers 1
a Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain
b Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, Spain
c Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
d Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
e Servicio de Urgencias, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain
f Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
g Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, Spain
h Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
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Tables (3)
Table 1. Baseline characteristics of the patients treated with digoxin included in this study and comparison according to whether treatment with digoxin was considered adequate or inadequate.
Table 2. Characteristics of the decompensation episodes of the patients treated with digoxin included in this study and comparison according to whether treatment with digoxin was considered adequate or inadequate.
Table 3. Characteristics of the decompensation episodes of the patients treated with digoxin included in this study and comparison according to whether treatment with digoxin was considered adequate or inadequate.
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Abstract
Objectives

To analyze the factors related to inadequate chronic treatment with digoxin and whether the inadequacy of treatment has an impact on short-term outcome.

Method

Patients diagnosed with AHF who were in chronic treatment with digoxin, were selected. Digoxin treatment was classified as adequate or inadequate. We investigated factors associated to inadequacy and whether such inadequacy was associated with in-hospital and 30-day mortality, prolonged hospital stay (>7 days) and combined adverse event (re-consultation to the ED or hospitalization for AHF or death from any cause) during the 30 days after discharge.

Results

We analyzed 2,366 patients on chronic digoxin treatment (median age = 83 years, women = 61%), which was considered adequate in 1,373 cases (58.0%) and inadequate in 993 (42.0%). The inadequacy was associated with older age, less comorbidity, less treatment with beta-blockers and renin-angiotensin inhibitors, better ventricular function, and worse Barthel index. In-hospital and 30-day mortality was higher in patients with inadequate digoxin treatment (9.9% versus 7.6%, p = 0.05; and 12.6% versus 9.1%, p < 0.001, respectively). No differences were recorded in prolonged stay (35.7% versus 33.8%) or post-discharge adverse events (32.9% versus 31.8%). In the model adjusted for baseline and decompensation episode differences, inadequate treatment with digoxin was not significantly associated with any outcome, with an odds ratio of 1.31 (95%CI = 0.85−2.03) for in-hospital mortality; 1.29 (0.74–2.25) for 30-day mortality; 1.07 (0.82−1.40) for prolonged stay; and 0.88 (0.65−1.19) for post-discharge adverse event.

Conclusion

There is a profile of patients with AHF who inadequately receive digoxin, although this inadequateness for chronic digitalis treatment was not associated with short-term adverse outcomes.

Keywords:
Acute heart failure
Digoxin
Mortality
Emergency department
Resumen
Objetivos

Analizar los factores relacionados con el tratamiento crónico inadecuado con digoxina y si esta inadecuación impacta en la evolución a corto plazo.

Método

Se incluyeron pacientes diagnosticados de ICA en tratamiento crónico con digoxina y se clasificaron como con tratamiento indicado o no indicado, investigándose los factores asociados a este hecho y si se asociaba a mortalidad intrahospitalaria, a 30 días, estancia hospitalaria prolongada (>7 días) y evento adverso combinado (reconsulta a urgencias, hospitalización por ICA o muerte por cualquier causa) durante los 30 días posalta.

Resultados

Se analizaron 2.366 pacientes en tratamiento crónico con digoxina (mediana = 83 años, mujeres = 61%): adecuado en 1.373 casos (58,0%), inadecuado en 993 (42,0%). La inadecuación se asoció con mayor edad, menor comorbilidad, menor tratamiento con betabloqueantes e IECAs, mejor función ventricular y peor índice de Barthel. La mortalidad intrahospitalaria y a 30 días fue mayor en pacientes con tratamiento inadecuado (9,9% versus 7,6%, p = 0,05; y 12,6% versus 9,1%, p < 0,001; respectivamente); no hubo diferencias en estancia prolongada (35,7% versus 33,8%) ni en eventos adversos posalta (32,9% versus 31,8%). Ajustando las diferencias basales y del episodio de descompensación, el tratamiento crónico inadecuado con digoxina no se asoció con ningún resultado, con odds ratio de 1,31 (IC95% = 0,85−2,03) para mortalidad intrahospitalaria; 1,29 (0,74–2,25) para mortalidad a 30 días; 1,07 (0,82−1,40) para estancia prolongada; y 0,88 (0,65–1,19) para evento adverso posalta.

Conclusión

Existe un perfil de paciente que recibe de forma inadecuada tratamiento crónico con digoxina, si bien ello no se asocia con resultados adversos a corto plazo durante los episodios de ICA.

Palabras clave:
Insuficiencia cardiaca aguda
Digoxina
Mortalidad
Urgencias

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