Emergency Department Visits and Hospitalizations for Digoxin Toxicity—United States, 2005–2010
Published Date:Dec 03 2013
Source:Circ Heart Fail. 7(1):28-34.
Adverse Drug Event
Aged, 80 And Over
Emergency Service, Hospital
Pubmed Central ID:PMC4697444
Funding:CC999999/Intramural CDC HHS/United States
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.
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.
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