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Withdrawal of maintenance digoxin from institutionalized elderly.
1Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
Postgraduate Medical Journal
|November 1, 1990
Summary
Discontinuing digoxin in elderly nursing home residents with sinus rhythm is often safe. This study found that 12 out of 14 patients tolerated digoxin withdrawal without adverse effects.
Area of Science:
- Geriatrics
- Clinical Pharmacology
- Cardiology
Background:
- Chronic digitalis use is prevalent in institutionalized elderly patients.
- Digitalis therapy carries risks of toxicity and adverse reactions.
- Optimizing medication regimens in the elderly is crucial for patient safety.
Purpose of the Study:
- To evaluate the safety and feasibility of discontinuing maintenance digoxin therapy.
- To assess the incidence of adverse events, including dysrhythmia and heart failure, after digoxin withdrawal in elderly residents.
- To determine if digoxin withdrawal can be safely achieved in this population.
Main Methods:
- A prospective study involving 14 elderly nursing home residents in sinus rhythm.
- Maintenance digoxin therapy was withdrawn for all participants.
- Subjects were monitored for 18 months for signs of dysrhythmia or heart failure.
Main Results:
- Digoxin withdrawal was successful in 12 out of 14 residents (85.7%) without negative consequences.
- One resident experienced supraventricular tachycardia requiring digoxin reinitiation.
- One resident developed left heart failure, managed with diuretics.
Conclusions:
- Maintenance digoxin can likely be safely withdrawn in elderly nursing home residents who are in sinus rhythm and have no prior history of atrial dysrhythmias.
- Careful monitoring is recommended during and after digoxin discontinuation.
- This finding supports medication de-prescribing strategies in geriatric care.