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Digoxin use and digoxin toxicity in the post-DIG trial era

Zainal Hussain1, Jason Swindle, Paul J Hauptman

  • 1Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.

Journal of Cardiac Failure
|June 10, 2006
PubMed

Insights

Digoxin use for heart failure has declined, yet digoxin toxicity cases requiring hospitalization have not decreased. Further research is needed to understand these trends in heart failure treatment.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Newer heart failure therapies with proven survival benefits challenge digoxin's role in patients with normal sinus rhythm, left ventricular dysfunction, and symptomatic heart failure.
  • The 1997 Digitalis Investigation Group (DIG) Trial did not show a significant impact of digoxin on mortality, further questioning its use.

Purpose of the Study:

  • To examine trends in digoxin use and toxicity following the introduction of newer heart failure medications.
  • To analyze patterns in digoxin toxicity and the use of its antidote in heart failure patients.

Main Methods:

  • Utilized data from a large heart failure registry to assess digoxin use at hospital admission.
  • Employed a surveillance system for toxic drug exposures to track digoxin toxicity.
  • Incorporated industry estimates for the use of digoxin antibody.

Main Results:

  • Digoxin use significantly decreased from 31.4% in 2001 to 23.5% in 2004 (P < .00001).
  • This decrease in digoxin use was independent of patient age, gender, or baseline creatinine.
  • The number of hospitalizations for toxic or potentially toxic digoxin exposures did not decrease concurrently.

Conclusions:

  • Despite a decline in digoxin prescriptions for heart failure, there has been no corresponding reduction in toxicity cases.
  • Further investigation is necessary to identify the reasons behind these trends and to evaluate prescribing practices for digoxin and its antidote.
Abstract

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