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Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post-transplant

Rasmus Rivinius1,2,3, Matthias Helmschrott1, Ann-Kathrin Rahm1,2,3

  • 1Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.

ESC Heart Failure
|July 2, 2020
PubMed

Insights

Combined use of amiodarone and digitalis before heart transplantation (HTX) significantly increases the risk of death within one year. This medication combination negatively impacts post-transplant survival and transplant success.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Pharmacology

Background:

  • Amiodarone and digitalis are common treatments for heart failure.
  • Both drugs have been individually linked to poorer outcomes after heart transplantation (HTX).
  • The combined effect of amiodarone and digitalis on post-HTX survival remains unclear.

Purpose of the Study:

  • To investigate the impact of combined amiodarone and digitalis use prior to HTX on patient survival.
  • To identify specific risk factors associated with this drug combination in HTX recipients.

Main Methods:

  • A registry study analyzed 600 patients undergoing HTX between 1989 and 2016.
  • Patients were stratified based on pre-HTX use of amiodarone and digitalis.
  • Outcomes included post-transplant survival, causes of death, and echocardiographic findings.

Main Results:

  • Patients receiving both amiodarone and digitalis before HTX had significantly worse 1-year survival (64.2% vs. 72.0% for amiodarone alone, P=0.01).
  • This group also showed a higher rate of death due to transplant failure (P=0.03) and adverse echocardiographic changes.
  • Multivariate analysis identified combined pre-HTX amiodarone and digitalis use as a significant risk factor for 1-year mortality (HR: 1.69, P=0.04).

Conclusions:

  • Combined pre-transplant amiodarone and digitalis therapy is associated with increased post-transplant mortality.
  • This drug combination poses a significant risk to heart transplant recipients.
  • Clinicians should carefully consider pre-transplant medication regimens when assessing HTX candidates.
Abstract

Keywords:
AmiodaroneDigitalisDigitoxinDigoxinHeart transplantationMortality

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