{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:08:45Z","timestamp":1760144925583,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed-up for a mean 37 months \u00b1 28 months. Digitalis use was assessed at the time of CRT implantation. A multivariate Cox-regression model and propensity score matching were used to determine all-cause mortality as the primary endpoint. CRT-response (defined as improvement of \u22651 NYHA class), echocardiographic improvement (defined as improvement of LVEF of \u2265 5%) and incidence of ICD shocks and rehospitalization were assessed as secondary endpoints in a subgroup of patients. (3) Results: The study comprised 552 CRT-recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and a higher NYHA class (all p \u2264 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR = 1.14; 95% CI 0.88\u20131.5; p = 0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR = 1.04; 95% CI 0.75\u20131.45; p = 0.82). Furthermore, in comparison to 286 propensity-score-matched patients, mortality was not affected by digitalis intake (propensity-adjusted HR = 1.11; 95% CI 0.72\u20131.70; p = 0.64). A CRT-response was predominant in digitalis non-users, concerning both improvement of HF symptoms and LVEF (NYHA p &lt; 0.01; LVEF p &lt; 0.01), while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock (p = 0.01); although, rehospitalization for cardiac reasons was significantly lower among digitalis users compared to digitalis non-users (HR = 0.58; 95% C. I. 0.40\u20130.85; p = 0.01). (4) Conclusions: Digitalis therapy had no effect on mortality, but was associated with a reduced response to CRT and increased susceptibility to ventricular arrhythmias requiring ICD shock treatment. Although, digitalis administration positively altered the likelihood for cardiac rehospitalization during follow-up.<\/jats:p>","DOI":"10.3390\/jcdd11060173","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T03:51:45Z","timestamp":1717386705000},"page":"173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT-Recipients"],"prefix":"10.3390","volume":"11","author":[{"given":"Julia W.","family":"Erath","sequence":"first","affiliation":[{"name":"Department of Cardiology, Goethe University Hospital, 60590 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolett","family":"Vigh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical Centre, Hungarian Defense Forces, 1062 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Balazs","family":"Muk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical Centre, Hungarian Defense Forces, 1062 Budapest, Hungary"},{"name":"Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carsten W.","family":"Israel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Evangelical Hospital, 33617 Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Keck","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Goethe University Hospital, 60590 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7232-9698","authenticated-orcid":false,"given":"David","family":"Pilecky","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabor Z.","family":"Duray","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical Centre, Hungarian Defense Forces, 1062 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1611-4443","authenticated-orcid":false,"given":"Mate","family":"Vamos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Goethe University Hospital, 60590 Frankfurt am Main, Germany"},{"name":"Cardiac Electrophysiology Division, Cardiology Center, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,3]]},"reference":[{"key":"ref_1","unstructured":"OECD Health Policy Studies (2024, April 01). 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