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

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.