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Reasons prompting digitalis therapy in the acute care hospital
R A Incalzi1, C Pedone, M Pahor
1Istituto di Medicina Interna e Geriatria, CE.M.I., Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
Digitalis use in elderly heart failure patients is complex. Clinical factors alone do not reliably predict prescription, suggesting physician-related factors influence treatment decisions for congestive heart failure (CHF).
Area of Science:
- Geriatrics
- Cardiology
- Clinical Pharmacology
Background:
- Digitalis use in elderly patients with congestive heart failure (CHF) lacks clear criteria due to efficacy and safety concerns.
- This study investigated if clinical characteristics at hospital admission predict digitalis therapy in older CHF patients.
Purpose of the Study:
- To determine if clinical factors predict digitalis prescription in elderly patients admitted to acute care hospitals.
- To analyze the relationship between patient characteristics and the decision to administer digitalis therapy.
Main Methods:
- A total of 1239 elderly patients were categorized into four groups based on CHF diagnosis likelihood (Carlson's score) and digitalis use.
- Discriminant analysis was employed to identify clinical variables differentiating these groups.
Main Results:
- Patients receiving digitalis, regardless of confirmed CHF, often had prior digoxin use, atrial fibrillation, advanced age, and comorbidities like COPD and renal failure.
- Clinical profiles across groups with and without definite CHF largely overlapped, indicating limited predictive power of these factors.
Conclusions:
- Age, prior digitalis use, and comorbidities may lead to seemingly inappropriate digitalis prescriptions in elderly patients.
- Clinical variables alone are insufficient to predict digitalis therapy; physician-related factors likely play a significant role.
Background:
The choice of administering digitalis to older patients with congestive heart failure (CHF) cannot be made on the account of univocally defined criteria because of uncertainty about efficacy and concern about safety of digitalis in this population. The purpose of this study was to verify whether the clinical characteristics on admission to the acute care hospital determine the use of digitalis therapy in elderly patients.
Methods:
A total of 1239 patients (mean age 77.8 +/- 7.1 years, range 65-100 years, males 49.8%) consecutively admitted to 69 General Medicine and Geriatrics wards over a 4-month period were grouped by combining two dichotomous factors (Carlson's score > 4: definite or possible diagnosis of CHF; Carlson's score < 5: unlikely diagnosis of CHF; in-hospital adoption of digitalis therapy: yes or no) as follows: Group A: Carlson's score > 4, digitalis (n = 413); Group B: Carlson's score > 4, no digitalis (n = 260); Group C: Carlson's score < 5, digitalis (n = 104); Group D: Carlson's score < 5, no digitalis (n = 462). Variables significantly distinguishing groups were entered into a discriminant analysis aimed at assessing the group specificity of individual clinical profiles.
Results:
Use of digoxin at home, atrial fibrillation, older age, and comorbidity (mainly COPD and chronic renal failure) characterized most of the patients given digoxin with or without a definite diagnosis of CHF. Clinical profiles of groups A, B, and C largely overlapped.
Conclusion:
Age, historical use of digitalis, and comorbidity might lead to seemingly incongruous digitalis prescription. The choice of adopting digitalis therapy cannot be reliably predicted on the basis of clinical variables only. Presently unexplored physician-related factors, such as cultural background, likely outweigh clinical variables in prompting digitalis prescription.