Inappropriate Use of Digoxin in Older Hospitalized Heart Failure Patients

Ahmed, Ali; Allman, Richard M.; DeLong, James F.

doi:10.1093/gerona/57.2.m138

Cited by 21 publications

(16 citation statements)

References 48 publications

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“…A systematic review of 35 educational intervention studies for patients with HF demonstrated that education improved knowledge, self-monitoring, medication adherence, time to hospitalization, and days in the hospital. 363 Patients who receive in-hospital education have higher knowledge scores at discharge and 1 year later when compared with those who did not receive in-hospital education. 364 Data have called into question the survival benefit of discharge education.…”

Section: Management Strategies For Stage Bmentioning

confidence: 92%

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2013 ACCF/AHA Guideline for the Management of Heart Failure

et al. 2013

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Section: Management Strategies For Stage Bmentioning

confidence: 92%

“…363 Patients need to understand how to monitor their symptoms and weight fluctuations, restrict their sodium intake, take their medications as prescribed, and stay physically active. Education regarding these recommendations is necessary, albeit not always sufficient, to significantly improve outcomes.…”

Section: Management Strategies For Stage Bmentioning

confidence: 99%

2013 ACCF/AHA Guideline for the Management of Heart Failure

et al. 2013

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“…8 Of 376 hospitalized patients with heart failure receiving digoxin, 223 (37%) had no appropriate indication for its use. 9 Therapeutic concentrations of digoxin do not decrease the frequency of episodes of paroxysmal AF or the duration of episodes of paroxysmal AF diagnosed by 24-h ambulatory electrocardiograms. 4,5 Digoxin has been shown to increase the duration of episodes of paroxysmal AF, a result consistent with its action in reducing the atrial refractory period.…”

Section: Discussionmentioning

confidence: 95%

Prevalence of Inappropriate Use of Digoxin in 136 Patients on Digoxin and Prevalence of Use of Warfarin or Aspirin in 89 Patients With Persistent or Paroxysmal Atrial Fibrillation

Lleva

Aronow²,

Gutwein³

2009

American Journal of Therapeutics

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Of 136 patients, mean age 72 years, receiving digoxin in the hospital or in the medical clinic, 47 (35%) had heart failure with reduced left ventricular ejection fraction and symptoms despite optimal medical therapy, 82 (60%) had persistent atrial fibrillation (AF), and 7 (5%) had paroxysmal AF. The prevalence of inappropriate use of digoxin was 5%. Of 89 patients with persistent or paroxysmal AF, 70 (79%) were being treated with warfarin to maintain an International Normalized Ratio between 2.0 and 3.0, 15 (17%) were being treated with aspirin 325 mg daily, and 4 (4%) were not being treated with warfarin or aspirin. The prevalence of nonuse of warfarin or aspirin in patients with persistent or paroxysmal AF was 4%.

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“…This is in line with the current still large use of this drug, despite the alert of a narrower therapeutic window in old patients. 17 The higher prevalence of atrial fibrillation in the older group probably does not account for this tendency and this is underlined in both groups by the reduction of digoxin therapy at discharge of the patients who were on digoxin treatment at admission.…”

Section: Discussionmentioning

confidence: 98%

Clinical characteristics of very old patients hospitalized in internal medicine wards for heart failure: a sub-analysis of the FADOI-CONFINE Study Group

Biagi¹,

Nardi²,

Baldo

et al. 2014

Ital J Med

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The incidence and prevalence of chronic heart failure are increasing worldwide, as is the number of very old patients (>85 years) affected by this disease. The aim of this sub-analysis of the multicenter, observational CONFINE study was to detect clinical and therapeutic peculiarities in patients with chronic heart failure aged >85 years. We recruited patients admitted with a diagnosis of chronic heart failure and present in the hospital in five index days, in 91 Units of Internal Medicine. The patients' clinical characteristics, functional and cognitive status, and the management of the heart failure were analyzed. A total of 1444 subjects were evaluated, of whom 329 (23.1%) were over 85 years old. Signs and symptoms of chronic heart failure were more common in very old patients, as were severe renal insufficiency, anemia, disability and cognitive impairment. The present survey found important age-related differences (concomitant diseases, cognitive status) among patients with chronic heart failure, as well as different therapeutic strategies and clinical outcome for patients over 85 years old. Since these patients are usually excluded from clinical trials and their management remains empirical, specific studies focused on the treatment of very old patients with chronic heart failure are needed.

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Inappropriate Use of Digoxin in Older Hospitalized Heart Failure Patients

Abstract: Background. Older adults are more likely to suffer from the adverse effects of digoxin. Studies have described the inappropriate use of digoxin in various populations. The objective of this study was to determine the correlates of inappropriate digoxin use in older heart failure patients.

Cited by 21 publications

References 48 publications

2013 ACCF/AHA Guideline for the Management of Heart Failure

2013 ACCF/AHA Guideline for the Management of Heart Failure

Prevalence of Inappropriate Use of Digoxin in 136 Patients on Digoxin and Prevalence of Use of Warfarin or Aspirin in 89 Patients With Persistent or Paroxysmal Atrial Fibrillation

Clinical characteristics of very old patients hospitalized in internal medicine wards for heart failure: a sub-analysis of the FADOI-CONFINE Study Group

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