Digoxin Therapy for Cor Pulmonale: A Systematic Review
Abstract Objective Right heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not established. The aim of this study is to conduct a systematic review of the literature to assess the relative benefits and harms of digoxin therapy i...
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Published in | International journal of cardiology Vol. 223; pp. 320 - 324 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
15.11.2016
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Abstract | Abstract Objective Right heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not established. The aim of this study is to conduct a systematic review of the literature to assess the relative benefits and harms of digoxin therapy in patients with RV failure. Methods We performed a literature search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) on Nov. 4, 2014. We did not use publication type, period or language restrictions to the search strategy. Exclusions included: trials that excluded patients with RV failure, included patients requiring mechanical or intravenous inotropic support, review papers and case reports. The primary outcome was long-term efficacy outcomes of digoxin in right heart failure. Two reviewers screened titles and abstracts of identified citations independently and in duplication using calibration exercises and standardized screening forms. Results The search strategy identified 4097 citations, and 4 studies were included in this analysis (n = 76 patients). Of the four studies, two assessed improvements in RVEF, two studies compared exercise capacity indexes, and one assessed symptoms with digoxin compared with placebo. No study assessed mortality outcomes. Overall, there was no statistically significant improvement in RVEF, exercise capacity, NYHA class, heart failure score, or body weight. Conclusions There are few studies evaluating digitalis use for RV failure, which are limited to patients with cor pulmonale. In these patients, digitalis use provides no improvement in RVEF, exercise capacity, or NYHA class. Randomized clinical trials are needed to address this question. |
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AbstractList | Right heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not established. The aim of this study is to conduct a systematic review of the literature to assess the relative benefits and harms of digoxin therapy in patients with RV failure.
We performed a literature search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) on Nov. 4, 2014. We did not use publication type, period or language restrictions to the search strategy. Exclusions included: trials that excluded patients with RV failure, included patients requiring mechanical or intravenous inotropic support, review papers and case reports. The primary outcome was long-term efficacy outcomes of digoxin in right heart failure. Two reviewers screened titles and abstracts of identified citations independently and in duplication using calibration exercises and standardized screening forms.
The search strategy identified 4097 citations, and 4 studies were included in this analysis (n=76 patients). Of the four studies, two assessed improvements in RVEF, two studies compared exercise capacity indexes, and one assessed symptoms with digoxin compared with placebo. No study assessed mortality outcomes. Overall, there was no statistically significant improvement in RVEF, exercise capacity, NYHA class, heart failure score, or body weight.
There are few studies evaluating Digitalis use for RV failure, which are limited to patients with cor pulmonale. In these patients, Digitalis use provides no improvement in RVEF, exercise capacity, or NYHA class. Randomized clinical trials are needed to address this question. Abstract Objective Right heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not established. The aim of this study is to conduct a systematic review of the literature to assess the relative benefits and harms of digoxin therapy in patients with RV failure. Methods We performed a literature search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) on Nov. 4, 2014. We did not use publication type, period or language restrictions to the search strategy. Exclusions included: trials that excluded patients with RV failure, included patients requiring mechanical or intravenous inotropic support, review papers and case reports. The primary outcome was long-term efficacy outcomes of digoxin in right heart failure. Two reviewers screened titles and abstracts of identified citations independently and in duplication using calibration exercises and standardized screening forms. Results The search strategy identified 4097 citations, and 4 studies were included in this analysis (n = 76 patients). Of the four studies, two assessed improvements in RVEF, two studies compared exercise capacity indexes, and one assessed symptoms with digoxin compared with placebo. No study assessed mortality outcomes. Overall, there was no statistically significant improvement in RVEF, exercise capacity, NYHA class, heart failure score, or body weight. Conclusions There are few studies evaluating digitalis use for RV failure, which are limited to patients with cor pulmonale. In these patients, digitalis use provides no improvement in RVEF, exercise capacity, or NYHA class. Randomized clinical trials are needed to address this question. OBJECTIVERight heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not established. The aim of this study is to conduct a systematic review of the literature to assess the relative benefits and harms of digoxin therapy in patients with RV failure.METHODSWe performed a literature search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) on Nov. 4, 2014. We did not use publication type, period or language restrictions to the search strategy. Exclusions included: trials that excluded patients with RV failure, included patients requiring mechanical or intravenous inotropic support, review papers and case reports. The primary outcome was long-term efficacy outcomes of digoxin in right heart failure. Two reviewers screened titles and abstracts of identified citations independently and in duplication using calibration exercises and standardized screening forms.RESULTSThe search strategy identified 4097 citations, and 4 studies were included in this analysis (n=76 patients). Of the four studies, two assessed improvements in RVEF, two studies compared exercise capacity indexes, and one assessed symptoms with digoxin compared with placebo. No study assessed mortality outcomes. Overall, there was no statistically significant improvement in RVEF, exercise capacity, NYHA class, heart failure score, or body weight.CONCLUSIONSThere are few studies evaluating Digitalis use for RV failure, which are limited to patients with cor pulmonale. In these patients, Digitalis use provides no improvement in RVEF, exercise capacity, or NYHA class. Randomized clinical trials are needed to address this question. |
Author | Baydoun, Atallah, MD Oliveira, Guilherme H., MD Alajaji, Wissam, MD Hanna, Mazen A., MD Al-Kindi, Sadeer G., MD Henry, Leslie, M.S.L.S |
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Cites_doi | 10.1378/chest.114.3.787 10.1002/ejhf.199 10.1002/ejhf.183 10.1161/CIRCULATIONAHA.113.008461 10.1378/chest.85.2.187 10.1164/rccm.200604-547OC 10.1161/01.CIR.1.2.161 10.1016/j.cardfail.2012.02.002 10.1161/CIRCULATIONAHA.106.628347 10.1002/ejhf.177 10.1056/NEJM199702203360801 10.7326/0003-4819-95-3-283 10.1002/ejhf.418 10.1161/CIRCULATIONAHA.109.887570 |
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Keywords | Chronic obstructive pulmonary disease Digoxin Pulmonary Hypertension Right Ventricular Function Right Heart Failure Mortality Chronic obstructive pulmonary disease digoxin Right heart failure Right ventricular function Pulmonary hypertension |
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Heart Fail. doi: 10.1002/ejhf.418 contributor: fullname: Aschauer – volume: 121 start-page: 252 year: 2010 ident: 10.1016/j.ijcard.2016.08.018_bb0005 article-title: Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.109.887570 contributor: fullname: Meyer |
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Snippet | Abstract Objective Right heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not... Right heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not established. The aim of... OBJECTIVERight heart failure is associated with increased mortality and morbidity. The optimal treatment for patients with RV failure is not established. The... |
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SubjectTerms | Cardiotonic Agents - therapeutic use Cardiovascular Chronic obstructive pulmonary disease digoxin Digoxin - therapeutic use Humans Mortality Pulmonary Heart Disease - drug therapy Pulmonary Heart Disease - physiopathology Pulmonary hypertension Right heart failure Right ventricular function Treatment Outcome |
Title | Digoxin Therapy for Cor Pulmonale: A Systematic Review |
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