Emergency Department Visits and Hospitalizations for Digoxin Toxicity—United States, 2005–2010

Details

• Alternative Title:
  Circ Heart Fail
• Personal Author:
  See, Isaac ; Shehab, Nadine ; Kegler, Scott R. ; Laskar, S. Raja ; Budnitz, Daniel S.
• Description:
  Background
  
  Recent data on digoxin prescribing and adverse events are lacking but could help inform the management of digoxin in contemporary heart failure treatment.
  
  Methods and Results
  
  We determined nationally-representative numbers and rates of emergency department (ED) visits for digoxin toxicity in the United States using 2005–2010 reports from the National Electronic Injury Surveillance System—Cooperative Adverse Drug Event Surveillance project and the National Ambulatory (and Hospital Ambulatory) Medical Care Surveys. Based on 441 cases, an estimated 5,156 (95% confidence interval [CI], 2,663–7,648) ED visits for digoxin toxicity occurred annually in the United States; over three-fourths (78.8% [95% CI, 73.5%–84.1%]) resulted in hospitalization. Serum digoxin level was ≥2.0 ng/mL for 95.8% (95% CI, 93.2%–98.4%) of estimated ED visits with levels reported (n=251 cases). The rate of ED visits per 10,000 outpatient prescription visits among patients ≥85 years was twice that of patients 40–84 years (rate ratio, 2.4 [95% CI, 1.2–5.0]); among females, the rate was twice that of males (rate ratio, 2.3 [95% CI, 1.1–4.7]). Digoxin toxicity accounted for an estimated 1.0% (95% CI, 0.6%–1.4%) of ED visits for all adverse drug events (ADEs) among patients ≥40 years, but an estimated 3.3% (95% CI, 2.3%–4.4%) of ED visits and 5.9% (95% CI, 4.0%–7.9%) of hospitalizations for all ADEs among patients ≥85 years. Estimated annual ED visits and hospitalizations remained relatively constant from 2005–2010.
  
  Conclusion
  
  Digoxin toxicity is not declining; more careful prescribing to high-risk groups and improved monitoring of serum levels might be needed to reduce morbidity from outpatient digoxin use.
  
  
• Subjects:
  Adult Adverse Drug Event Aged Aged, 80 And Over Age Factors Ambulatory Care Anti-Arrhythmia Agents Article Digoxin Disease Management Emergency Department Emergency Service, Hospital Female Heart Failure Hospitalization Humans Male Middle Aged Rehospitalization Retrospective Studies Risk Factors Sex Factors United States

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• Source:
  Circ Heart Fail. 7(1):28-34.
• Pubmed ID:
  24300242
• Pubmed Central ID:
  PMC4697444
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Volume:
  7
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:01551d8feaa86c40d665e9819fd053f053da964a9a690faff6d93cd7d6246b1c
• Download URL:
  https://stacks.cdc.gov/view/cdc/37152/cdc_37152_DS1.pdf
• File Type:
  [PDF - 154.62 KB ]