Clinical issues related to discontinuing digoxin therapy in elderly nursing home patients

Digoxin is commonly used to treat congestive heart failure. Digoxin augments ventricular systolic performance, but does not benefit patients whose congestive heart failure is caused by poor diastolic function. We studied 47 elderly nursing home patients who were receiving long-term digoxin therapy. The left ventricular ejection fractions were measured using both a standard and a highly portable echocardiography machine. Thirty-five of 47 patients had normal ejection fractions (50% or greater). In this subgroup, 23 patients were in normal sinus rhythm. Digoxin was discontinued in 14 patients with good systolic function and normal sinus rhythm, but in nine cases physicians refused to stop the digoxin. Follow-up evaluations showed no deterioration off digoxin. Excellent correlations existed between estimated left ventricular ejection fractions from the two echocardiography machines. Many nursing home patients taking digoxin do not need it. Physician reluctance to discontinue digoxin may change with the availability of highly portable echocardiography.