Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study.

INTRODUCTION AND OBJECTIVES: We aimed to assess and compare the effect of digoxin on clinical outcomes in patients with atrial fibrillation vs those under beta-blockers or none of these drugs. METHODS: AFBAR is a prospective registry study carried out by a team of primary care physicians (n=777 patients). Primary endpoints were survival, survival free of admission due to any cause, and survival free of admission due to cardiovascular causes. The mean follow up was 2.9 years. Four groups were analyzed: patients receiving digoxin, beta-blockers, or digoxin plus beta-blockers, and patients receiving none of these drugs. RESULTS: Overall, 212 patients (27.28%) received digoxin as the only heart control strategy, 184 received beta-blockers (23.68%), 58 (7.46%) were administered both, and 323 (41.57%) received none of these drugs. Digoxin was not associated with all-cause mortality (estimated hazard ratio=1.42; 95% confidence interval, 0.77-2.60; P=.2), admission due to any cause (estimated hazard ratio=1.03; 95% confidence interval, 0.710-1.498; P=.8), or admission due to cardiovascular causes (estimated hazard ratio=1.193; 95% confidence interval, 0.725-1.965; P=.4). No association was found between digoxin use and all-cause mortality, admission due to any cause, or admission due to cardiovascular causes in patients without heart failure. There was no interaction between digoxin use and sex in all-cause mortality or in survival free of admission due to any cause. However, an association was found between sex and admission due to cardiovascular causes. CONCLUSIONS: Digoxin was not associated with increased all-cause mortality, survival free of admission due to any cause, or admission due to cardiovascular causes, regardless of underlying heart failure.

Seguimiento clínico de una muestra contemporánea de pacientes con fibrilación auricular en tratamiento con digoxina: resultados del estudio AFBAR / Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study

Introducción y objetivos: Evaluar el efecto de la digoxina en los resultados clínicos de los pacientes con fibrilación auricular con y sin tratamiento con bloqueadores beta. Métodos El AFBAR es un registro prospectivo llevado a cabo por un equipo de médicos de atención primaria (n = 777 pacientes). Los objetivos principales fueron la supervivencia, la supervivencia libre de hospitalización por cualquier causa y la supervivencia libre de hospitalización por causas cardiovasculares. La media de seguimiento fue 2,9 años. Se analizaron cuatro grupos: pacientes tratados con digoxina, bloqueadores beta o digoxina más bloqueadores beta, y pacientes que no recibían ninguno de estos fármacos. Resultados En total, 212 pacientes (27,28%) recibieron digoxina como única estrategia de control de frecuencia; 184 recibieron bloqueadores beta (23,68%); 58 (7,46%), ambos fármacos y 323 (41,57%), ninguno de ellos. El tratamiento con digoxina no se asoció a la mortalidad por todas las causas (razón de riesgos estimada = 1,42; intervalo de confianza del 95%, 0,710-1,498; p = 0,2), la hospitalización por todas las causas (razón de riesgos estimada = 1,03; intervalo de confianza del 95%, 0,71-1,49; p = 0,8) ni la hospitalización por causas cardiovasculares (razón de riesgos estimada = 1,193; intervalo de confianza del 95%, 0,725-1,965; p = 0,4). No se observó asociación entre el empleo de digoxina y la mortalidad por cualquier causa, la hospitalización por cualquier causa o la hospitalización por causas cardiovasculares en los pacientes sin insuficiencia cardiaca. No hubo interacción entre el uso de digoxina y el sexo en cuanto a la mortalidad por todas las causas o la supervivencia sin hospitalización por todas las causas. Sin embargo, sí se observó una asociación entre el sexo y la hospitalización por causa cardiovascular. Conclusiones: La digoxina no se asoció a un aumento de la mortalidad por cualquier causa, la supervivencia libre de hospitalización por cualquier causa ni la supervivencia libre de hospitalización por causas cardiovasculares, con independencia de la presencia de insuficiencia cardiaca subyacente (AU)

Introduction and objectives We aimed to assess and compare the effect of digoxin on clinical outcomes in patients with atrial fibrillation vs those under beta-blockers or none of these drugs. We compared the incidence of ventricular arrhythmias in patients who were undergoing cardiac resynchronization therapy with an implantable cardioverter-defibrillator in terms of the degree of echocardiographic response to resynchronization. Patients were classified in 3 subgroups; super-responders, responders, and nonresponders. Methods AFBAR is a prospective registry study carried out by a team of primary care physicians (n = 777 patients). Primary endpoints were survival, survival free of admission due to any cause, and survival free of admission due to cardiovascular causes. The mean follow up was 2.9 years. Four groups were analyzed: patients receiving digoxin, beta-blockers, or digoxin plus beta-blockers, and patients receiving none of these drugs. Conclusions Digox in was not associated with increased all-cause mortality, survival free of admission due to any cause, or admission due to cardiovascular causes, regardless of underlying heart failure(AU)

Determinants of cardiovascular mortality in a cohort of primary care patients with chronic ischemic heart disease. BARBANZA Ischemic Heart Disease (BARIHD) study.

BACKGROUND: Prognosis of chronic patients with established ischemic heart disease (IHD) is not fully understood. The objective was to determine which factors are related to cardiovascular death and hospitalizations in patients with IHD within a primary care network. MATERIALS AND METHODS: A cohort study was carried out by 69 primary care providers in Spain in 2007. Participants were followed up for a mean of 2.2 ± 0.3 years. 1095 patients were recruited if they had established (at least 1 year of known disease) IHD (myocardial infarction or and stable or unstable angina). Several hypothesized determinants of cardiovascular mortality were studied, using Cox proportional hazard regression models. Subgroup analysis was also performed for participants without cardiovascular admissions within the last year. RESULTS: Mean time since first IHD diagnosis was 7.6 ± 6.0 years. Annual all-cause mortality rate was 3.25%, with 44 cardiovascular deaths and 119 cardiovascular admissions. The main prognostic factor for cardiovascular death was previous heart failure (hazard ratio [HR] 4.32, 95% confidence interval [CI] 2.30 to 8.11, p<0.001). Recent cardiovascular admission doubled the risk for death (HR 2.01, CI 1.06 to 3.81, p=0.031). Results showed that use of beta blockers and increased physical activity were the main protective factors. Patients without a recent cardiovascular admission showed previous heart failure as the main significant factor for cardiovascular death. CONCLUSIONS: Patients with chronic IHD in a primary care setting may need a closer follow-up in the presence of previous conditions such as heart failure. Physical activity and treatment with beta blockers were the factors giving these patients the greatest protection.