Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality
Abstract Aims Amiodarone and digitalis are frequently used drugs in patients with heart failure. Both have separately been linked to reduced post‐transplant survival, but their combined impact on mortality after HTX remains uncertain. This study investigated the effects of combined amiodarone and di...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-10-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.12807 |
| _version_ | 1818432060715433984 |
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| author | Rasmus Rivinius Matthias Helmschrott Ann‐Kathrin Rahm Fabrice F. Darche Dierk Thomas Tom Bruckner Andreas O. Doesch Philipp Ehlermann Hugo A. Katus Edgar Zitron |
| author_facet | Rasmus Rivinius Matthias Helmschrott Ann‐Kathrin Rahm Fabrice F. Darche Dierk Thomas Tom Bruckner Andreas O. Doesch Philipp Ehlermann Hugo A. Katus Edgar Zitron |
| author_sort | Rasmus Rivinius |
| collection | DOAJ |
| description | Abstract Aims Amiodarone and digitalis are frequently used drugs in patients with heart failure. Both have separately been linked to reduced post‐transplant survival, but their combined impact on mortality after HTX remains uncertain. This study investigated the effects of combined amiodarone and digitalis use before HTX on post‐transplant outcomes. Methods and results This registry study analysed 600 patients receiving HTX at Heidelberg Heart Center between 1989 and 2016. Patients were stratified by amiodarone and digitalis use before HTX. Analysis included patient characteristics, medication, echocardiographic features, heart rates, permanent pacemaker implantation, atrial fibrillation, and post‐transplant survival including causes of death. One hundred eighteen patients received amiodarone before HTX (19.7%), hereof 67 patients with digitalis (56.8%) and 51 patients without digitalis before HTX (43.2%). Patients with and without amiodarone before HTX showed a similar 1 year post‐transplant survival (72.0% vs. 78.4%, P = 0.11), but patients with combined amiodarone and digitalis before HTX had a worse 1 year post‐transplant survival (64.2%, P = 0.01), along with a higher percentage of death due to transplant failure (P = 0.03). Echocardiographic analysis of these patients showed a higher percentage of an enlarged right ventricle (P = 0.02), left atrium (P = 0.02), left ventricle (P = 0.03), and a higher rate of reduced left ventricular ejection fraction (P = 0.03). Multivariate analysis indicated combined amiodarone and digitalis use before HTX as a significant risk factor for 1 year mortality after HTX (hazard ratio: 1.69; 95% confidence interval: 1.02–2.77; P = 0.04). Conclusions Combined pre‐transplant amiodarone and digitalis therapy is associated with increased post‐transplant mortality. |
| first_indexed | 2024-12-14T15:59:12Z |
| format | Article |
| id | doaj.art-a297b1b3e3dc4e6bbdc12b4d61d785b2 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-14T15:59:12Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-a297b1b3e3dc4e6bbdc12b4d61d785b22022-12-21T22:55:13ZengWileyESC Heart Failure2055-58222020-10-01752082209210.1002/ehf2.12807Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortalityRasmus Rivinius0Matthias Helmschrott1Ann‐Kathrin Rahm2Fabrice F. Darche3Dierk Thomas4Tom Bruckner5Andreas O. Doesch6Philipp Ehlermann7Hugo A. Katus8Edgar Zitron9Department of Cardiology, Angiology and Pneumology Heidelberg University Hospital Im Neuenheimer Feld 410 Heidelberg 69120 GermanyDepartment of Cardiology, Angiology and Pneumology Heidelberg University Hospital Im Neuenheimer Feld 410 Heidelberg 69120 GermanyDepartment of Cardiology, Angiology and Pneumology Heidelberg University Hospital Im Neuenheimer Feld 410 Heidelberg 69120 GermanyDepartment of Cardiology, Angiology and Pneumology Heidelberg University Hospital Im Neuenheimer Feld 410 Heidelberg 69120 GermanyDepartment of Cardiology, Angiology and Pneumology Heidelberg University Hospital Im Neuenheimer Feld 410 Heidelberg 69120 GermanyInstitute for Medical Biometry and Informatics University of Heidelberg Heidelberg GermanyDepartment of Cardiology, Angiology and Pneumology Heidelberg University Hospital Im Neuenheimer Feld 410 Heidelberg 69120 GermanyDepartment of Cardiology, Angiology and Pneumology Heidelberg University Hospital Im Neuenheimer Feld 410 Heidelberg 69120 GermanyDepartment of Cardiology, Angiology and Pneumology Heidelberg University Hospital Im Neuenheimer Feld 410 Heidelberg 69120 GermanyDepartment of Cardiology, Angiology and Pneumology Heidelberg University Hospital Im Neuenheimer Feld 410 Heidelberg 69120 GermanyAbstract Aims Amiodarone and digitalis are frequently used drugs in patients with heart failure. Both have separately been linked to reduced post‐transplant survival, but their combined impact on mortality after HTX remains uncertain. This study investigated the effects of combined amiodarone and digitalis use before HTX on post‐transplant outcomes. Methods and results This registry study analysed 600 patients receiving HTX at Heidelberg Heart Center between 1989 and 2016. Patients were stratified by amiodarone and digitalis use before HTX. Analysis included patient characteristics, medication, echocardiographic features, heart rates, permanent pacemaker implantation, atrial fibrillation, and post‐transplant survival including causes of death. One hundred eighteen patients received amiodarone before HTX (19.7%), hereof 67 patients with digitalis (56.8%) and 51 patients without digitalis before HTX (43.2%). Patients with and without amiodarone before HTX showed a similar 1 year post‐transplant survival (72.0% vs. 78.4%, P = 0.11), but patients with combined amiodarone and digitalis before HTX had a worse 1 year post‐transplant survival (64.2%, P = 0.01), along with a higher percentage of death due to transplant failure (P = 0.03). Echocardiographic analysis of these patients showed a higher percentage of an enlarged right ventricle (P = 0.02), left atrium (P = 0.02), left ventricle (P = 0.03), and a higher rate of reduced left ventricular ejection fraction (P = 0.03). Multivariate analysis indicated combined amiodarone and digitalis use before HTX as a significant risk factor for 1 year mortality after HTX (hazard ratio: 1.69; 95% confidence interval: 1.02–2.77; P = 0.04). Conclusions Combined pre‐transplant amiodarone and digitalis therapy is associated with increased post‐transplant mortality.https://doi.org/10.1002/ehf2.12807AmiodaroneDigitalisDigoxinDigitoxinHeart transplantationMortality |
| spellingShingle | Rasmus Rivinius Matthias Helmschrott Ann‐Kathrin Rahm Fabrice F. Darche Dierk Thomas Tom Bruckner Andreas O. Doesch Philipp Ehlermann Hugo A. Katus Edgar Zitron Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality ESC Heart Failure Amiodarone Digitalis Digoxin Digitoxin Heart transplantation Mortality |
| title | Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality |
| title_full | Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality |
| title_fullStr | Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality |
| title_full_unstemmed | Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality |
| title_short | Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality |
| title_sort | combined amiodarone and digitalis therapy before heart transplantation is associated with increased post transplant mortality |
| topic | Amiodarone Digitalis Digoxin Digitoxin Heart transplantation Mortality |
| url | https://doi.org/10.1002/ehf2.12807 |
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