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

Rasmus Rivinius1, Matthias Helmschrott1, Arjang Ruhparwar2

  • 1Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg.

Therapeutics and Clinical Risk Management
|October 28, 2017
PubMed

Insights

Digitalis therapy before heart transplantation (HTX) is linked to worse survival rates. This study found pre-transplant digitalis use independently increases the risk of post-transplant mortality, highlighting concerns about its use in heart failure patients awaiting HTX.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Pharmacology

Background:

  • Digitalis therapy for heart failure remains controversial, with recent data suggesting increased mortality.
  • The impact of chronic digitalis use before heart transplantation (HTX) on post-transplant outcomes requires further investigation.

Purpose of the Study:

  • To investigate the effects of chronic digitalis therapy prior to HTX on posttransplant outcomes.
  • To determine if pre-transplant digitalis use is associated with increased mortality or atrial fibrillation after HTX.

Main Methods:

  • Retrospective, observational, single-center study of 530 adult patients undergoing HTX between 1989 and 2012.
  • Comparison of patients with digitalis therapy (≥3 months) versus those without prior to HTX.
  • Analysis of early posttransplant atrial fibrillation and mortality as primary outcomes.

Main Results:

  • Patients on digitalis prior to HTX showed significantly lower 30-day and 2-year survival rates.
  • Pre-transplant digitalis therapy was identified as an independent risk factor for 30-day posttransplant mortality (HR=2.097).
  • No significant difference in survival or atrial fibrillation was observed between digoxin and digitoxin use.

Conclusions:

  • Digitalis therapy in patients preceding HTX is an independent risk factor for elevated posttransplant mortality.
  • These findings suggest a need to re-evaluate the use of digitalis in heart failure patients awaiting transplantation.
Abstract

Keywords:
atrial fibrillationdigitalisheart transplantationmortality

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