Audit of digoxin prescribing in ambulatory patients

Digoxin prescribing for ambulatory patients with uncomplicated congestive heart failure in normal sinus rhythm (UCHF) was evaluated. The audit was conducted at a hospital primary care clinic and was performed retrospectively over a recent 2-year period. The audit focused on the discontinuance of digoxin prescribing and the attendant monitoring necessary. There was 34 patients prescribed digoxin during the study period who were classified as UCHF. Of these, 23 (68%) met our a priori criteria for digoxin discontinuance. However, only three of the 23 were discontinued and none met the criteria for proper follow-up. With regard to monitoring, the average patient was seen once every 2 months, but in fewer than half of the visits the patient was assessed on basic subjective and objective parameters of CHF status and digoxin toxicity. These results are being used in an educational program for the clinic physicians who before the audit had perceived their care of digoxin patients to be optimal.