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Digitalis in the treatment of heart failure in the elderly. The GIFA study results

L Carosella1, M Pahor, C Pedone

  • 1Department of Internal Medicine and Geriatrics, Catholic University, Largo F. Vito 1, Rome, Italy.

Archives of Gerontology and Geriatrics
|November 1, 1996
PubMed

Insights

Digoxin remains a common heart failure (HF) treatment, especially for the elderly. While generally safe with low adverse drug reactions (ADRs), toxicity risks increase in patients over 80.

Area of Science:

  • Cardiology
  • Pharmacology
  • Geriatrics

Background:

  • Digitalis glycosides, like digoxin, have been used for heart failure (HF) for over 200 years.
  • Despite new HF therapies, digoxin remains widely prescribed, particularly for elderly patients.
  • Concerns exist regarding digoxin's role in HF with sinus rhythm and its impact on mortality.

Purpose of the Study:

  • To evaluate the prescription patterns and adverse drug reactions (ADRs) of digoxin in hospitalized elderly patients.
  • To assess the appropriateness of digoxin use and identify risk factors for toxicity.

Main Methods:

  • Analysis of data from the Italian Group of Pharmacosurveillance in the Elderly (GIFA) study.
  • Monitoring of 20,047 hospitalized patients across three observation periods (1988, 1991, 1993).
  • Assessment of digoxin prescription appropriateness, dosage, and incidence of ADRs.

Main Results:

  • Digoxin was the most frequently prescribed drug for HF management in the monitored population.
  • Inappropriate digoxin prescriptions were uncommon, with low mean daily dosages used.
  • The incidence rate of digoxin-related ADRs was low compared to earlier studies, likely due to improved pharmacokinetics understanding and lower dosages.
  • Digoxin toxicity was significantly more frequent in patients aged 80 years and older.

Conclusions:

  • Digoxin offers clinical benefits in chronic HF, even in patients with sinus rhythm, and is cost-effective and easy to administer.
  • While generally safe, increased vigilance for digoxin toxicity is warranted in very elderly patients (≥80 years).
  • Optimized dosing and pharmacokinetics knowledge contribute to reduced ADRs in the elderly population.

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