Effect of digoxin noncompliance on hospitalization and mortality in patients with heart failure in long-term therapy: a prospective cohort study

Miura, Takanori; Kojima, Ryoji; Mizutani, Masaru; Shiga, Yukio; Takatsu, Fumimaro; Suzuki, Yoshio

doi:10.1007/s002280100272

Cited by 53 publications

(36 citation statements)

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“…Poor adherence to prescribed medication increases the risk of mortality and morbidity in patients with HF. [17][18][19][20] In a study that followed-up a cohort of patients for 6 years, the number of hospitalizations reported in nonadherent patients was Ͼ2.5 times higher than that among adherent patients. 19 Lower medication adherence was significantly associated with an increased number of cardiovascular-related emergency department visits.…”

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confidence: 85%

Factors influencing medication adherence in patients with heart failure

Moser

Lennie

et al. 2008

Heart & Lung

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confidence: 85%

Factors influencing medication adherence in patients with heart failure

Moser

Lennie

et al. 2008

Heart & Lung

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“…The current analysis is also distinguished from prior studies by its adjustment for SDC. In 1 study digoxin in HF patients with increased heart rate, after 72 months of follow-up, compared with patients who were adherent with their digoxin therapy, those who were non-adherent had increased mortality and hospitalizations.. 20 In that study, SDC was used to determine adherence to digoxin therapy.…”

Section: Discussionmentioning

confidence: 99%

Effects of Discontinuation of Digoxin Versus Continuation at Low Serum Digoxin Concentrations in Chronic Heart Failure

Ahmed¹,

Gambassi²,

Weaver³

et al. 2007

The American Journal of Cardiology

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Discontinuation of digoxin is associated with worsening heart failure (HF) symptoms. However, the long-term effects of discontinuation of chronic digoxin therapy on mortality and morbidity in HF have not been well studied. Of the 7788 Digoxin Investigation Group trial participants, 3365 were receiving digoxin before randomization. During the trial, digoxin was continued in 1666 patients and discontinued in 1699 patients. Using multivariable Cox regression analyses, we at first determined the effect of discontinuation of digoxin on mortality and hospitalization during 39.7 months of median follow up. Of the 1666 patients continued on digoxin, 457 had low (0.5-0.9 ng/ml) and 340 had high (≥1.0 ng/ml) serum digoxin concentrations (SDC) after 1 month of therapy and of the 1699 patients whose digoxin was discontinued, 1674 were alive at 1 month. We examined the effects of continuation of digoxin at low or high SDC. Compared with continuation of chronic digoxin therapy, discontinuation of digoxin was associated with significant increase in all-cause hospitalization (adjusted hazard ratio {AHR}=1.18; 95% confidence interval {CI}=1.09-1.28; P<0.0001) and HF hospitalization (AHR=1.35; 95% CI=1.20-1.51; P<0.0001), but had no effect on all cause mortality (AHR=1.06; 95% CI=0.95-1.19; P=0.272). Continuation of digoxin at low SDC, on the other hand, was associated with reduction in all-cause mortality (AHR=0.75; 95% CI=0.63-0.90; P=0.002), allcause hospitalization (AHR=0.80; 95% CI=0.71-0.91; P=0.001) and HF hospitalization (AHR=0.60; 95% CI=0.50-0.73; P<0.0001). In conclusion, continuation of chronic digoxin therapy at low SDC was associated with reduction in mortality and hospitalization in ambulatory chronic HF patients receiving background therapy with ACE inhibitors and diuretics. KeywordsHeart failure; digoxin; discontinuation; mortality; hospitalization The American College of Cardiology / American Heart Association (ACC/AHA) guideline for chronic heart failure (HF) recommends continuation of long-term digoxin therapy in HF patients who are already receiving this drug. 1 Discontinuation of digoxin is associated with worsening heart failure (HF) symptoms. 2-4 However, little is known about the long-term effect of discontinuation of chronic digoxin therapy on mortality and morbidity in patients with ambulatory chronic heart failure (HF). Even less is known about the effect of continuation of long-term digoxin therapy at low serum digoxin concentration (SDC). In the Digitalis Investigation Group (DIG) trial, 3365 (43%) of the 7788 patients were receiving digoxin at the time of enrollment. 5 These patients were randomized to discontinue (placebo arm) or continue (digoxin arm) their chronic digoxin therapy. Data on SDC were collected in a random subset of DIG participants and post hoc analysis using SDC data suggest that the effect of digoxin on outcomes in HF may be dependent on SDC. 6,7 These provide a unique opportunity to rapidly and efficiently determine the long-term effect of discontinuation of digoxin as we...

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“…Прямые методы представляют собой определение содержания препарата или его метаболитов в крови или моче [19]. Они достаточно дороги, представля ют определенные неудобства для пациентов и, глав ное, разработаны лишь для очень небольшого числа препаратов.…”

Section: сахарный диабетunclassified

Soblyudenie bol'nymi sakharnym diabetom rekomendatsiy vracha: vliyanie na effektivnost' terapii, metody otsenki, puti vozdeystviya

Суркова¹

2004

Diabetes mellitus

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Соблюдение больными сахарным диабетом рекомендаций врача: влияние на эффективность терапии, методы оценки, пути воздействия Е.В. Суркова ГУ Эндокринологический научный центр I (дир. -акад. РАН и РАМН И.И. Дедов) РАМН, Москва \ ффективность лечения сахарного диабета У-Ж (СД) определяется не только адекватным Ч-/ использованием современного арсенала тера певтических средств, но и участием пациента в про цессе контроля и лечения заболевания. Врач опреде ляет терапевтическую тактику в зависимости от типа СД, тяжести состояния больного, сопутствующей патологии и формулирует для пациента перечень ре комендаций, как правило, весьма обширный. Одна ко результаты лечения при этом заболевании всегда опосредованы поведением пациента, так как именно он выполняет (в той или иной мере) назначения вра ча, касающиеся диеты, физических нагрузок, само контроля гликемии, приема медикаментов и др.Соблюдение больным рекомендаций врача явля ется важнейшей составляющей поведения пациента, связанного с заболеванием (или «медицинского пове дения»), которое формируется под воздействием множества факторов как внешнего, так и внутрен него характера (см. схему).

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Effect of digoxin noncompliance on hospitalization and mortality in patients with heart failure in long-term therapy: a prospective cohort study

Abstract: These results indicate that digoxin noncompliance, at least in part, increases the rate of both hospitalization and mortality due to worsening heart failure in outpatients who have congestive heart failure with tachycardia in long-term therapy.

Cited by 53 publications

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Factors influencing medication adherence in patients with heart failure

Factors influencing medication adherence in patients with heart failure

Effects of Discontinuation of Digoxin Versus Continuation at Low Serum Digoxin Concentrations in Chronic Heart Failure

Soblyudenie bol'nymi sakharnym diabetom rekomendatsiy vracha: vliyanie na effektivnost' terapii, metody otsenki, puti vozdeystviya

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