Suveen Angraal1, Sudhakar V Nuti2, Frederick A Masoudi3, James V Freeman4, Karthik Murugiah5, Nilay D Shah6, Nihar R Desai4, Isuru Ranasinghe7, Yun Wang8, Harlan M Krumholz9. 1. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn. 2. Yale School of Medicine, New Haven, Conn. 3. Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colo. 4. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn. 5. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn. 6. Department of Health Sciences Research, Mayo Clinic, Rochester, Minn. 7. Discipline of Medicine, University of Adelaide, South Australia. 8. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Department of Biostatistics, Harvard School of Public Health, Boston, Mass. 9. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn. Electronic address: harlan.krumholz@yale.edu.
Abstract
BACKGROUND: Over the past 2 decades, guidelines for digoxin use have changed significantly. However, little is known about the national-level trends of digoxin use, hospitalizations for toxicity, and subsequent outcomes over this time period. METHODS: To describe digoxin prescription trends, we conducted a population-level, cohort study using data from IQVIA, Inc.'s National Prescription Audit (2007-2014) for patients aged ≥65 years. Further, in a national cohort of Medicare fee-for-service beneficiaries aged ≥65 years in the United States, we assessed temporal trends of hospitalizations associated with digoxin toxicity and the outcomes of these hospitalizations between 1999 and 2013. RESULTS: From 2007 through 2014, the number of digoxin prescriptions dispensed decreased by 46.4%; from 8,099,856 to 4,343,735. From 1999 through 2013, the rate of hospitalizations with a principal or secondary diagnosis of digoxin toxicity decreased from 15 to 2 per 100,000 person-years among Medicare fee-for-service beneficiaries. In-hospital and 30-day mortality rates associated with hospitalization for digoxin toxicity decreased significantly among Medicare fee-for-service beneficiaries; from 6.0% (95% confidence interval [CI], 5.2-6.8) to 3.7% (95% CI, 2.2-5.7) and from 14.0% (95% CI, 13.0-15.2) to 10.1% (95% CI, 7.6-13.0), respectively. Rates of 30-day readmission for digoxin toxicity decreased from 23.5% (95% CI, 22.1-24.9) in 1999 to 21.7% (95% CI, 18.0-25.4) in 2013 (P < .05). CONCLUSION: While digoxin prescriptions have decreased, it is still widely prescribed. However, the rate of hospitalizations for digoxin toxicity and adverse outcomes associated with these hospitalizations have decreased. These findings reflect the changing clinical practice of digoxin use, aligned with the changes in clinical guidelines.
BACKGROUND: Over the past 2 decades, guidelines for digoxin use have changed significantly. However, little is known about the national-level trends of digoxin use, hospitalizations for toxicity, and subsequent outcomes over this time period. METHODS: To describe digoxin prescription trends, we conducted a population-level, cohort study using data from IQVIA, Inc.'s National Prescription Audit (2007-2014) for patients aged ≥65 years. Further, in a national cohort of Medicare fee-for-service beneficiaries aged ≥65 years in the United States, we assessed temporal trends of hospitalizations associated with digoxintoxicity and the outcomes of these hospitalizations between 1999 and 2013. RESULTS: From 2007 through 2014, the number of digoxin prescriptions dispensed decreased by 46.4%; from 8,099,856 to 4,343,735. From 1999 through 2013, the rate of hospitalizations with a principal or secondary diagnosis of digoxintoxicity decreased from 15 to 2 per 100,000 person-years among Medicare fee-for-service beneficiaries. In-hospital and 30-day mortality rates associated with hospitalization for digoxintoxicity decreased significantly among Medicare fee-for-service beneficiaries; from 6.0% (95% confidence interval [CI], 5.2-6.8) to 3.7% (95% CI, 2.2-5.7) and from 14.0% (95% CI, 13.0-15.2) to 10.1% (95% CI, 7.6-13.0), respectively. Rates of 30-day readmission for digoxintoxicity decreased from 23.5% (95% CI, 22.1-24.9) in 1999 to 21.7% (95% CI, 18.0-25.4) in 2013 (P < .05). CONCLUSION: While digoxin prescriptions have decreased, it is still widely prescribed. However, the rate of hospitalizations for digoxintoxicity and adverse outcomes associated with these hospitalizations have decreased. These findings reflect the changing clinical practice of digoxin use, aligned with the changes in clinical guidelines.
Authors: Simon Sostaric; Aaron C Petersen; Craig A Goodman; Xiaofei Gong; Tai-Juan Aw; Malcolm J Brown; Andrew Garnham; Collene H Steward; Kate T Murphy; Kate A Carey; James Leppik; Steve F Fraser; David Cameron-Smith; Henry Krum; Rodney J Snow; Michael J McKenna Journal: J Physiol Date: 2022-08-02 Impact factor: 6.228