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The need for reassessment of digoxin prescribing for the elderly
1Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin.
Insights
Many elderly patients in nursing homes receive low-dose digoxin, but serum levels are often subtherapeutic. This suggests a need to reassess the necessity and dosage of maintenance digoxin in this population.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacy
- Cardiology
Background:
- Digoxin is commonly prescribed for elderly patients, often for atrial fibrillation and heart failure.
- Appropriate dosing and monitoring are crucial for efficacy and safety, especially in the elderly population.
- Subtherapeutic serum concentrations may lead to undertreatment and adverse outcomes.
Purpose of the Study:
- To assess the prevalence and circumstances of digoxin prescribing in nursing home residents.
- To evaluate the appropriateness of digoxin dosage and serum concentrations in this population.
Main Methods:
- A cross-sectional study was conducted in five private nursing homes.
- Data on patient demographics, digoxin dosage, rhythm, and serum digoxin concentrations were collected.
- Prevalence of digoxin use and proportion of patients with subtherapeutic levels were calculated.
Main Results:
- Forty-one patients (21% of residents) were prescribed digoxin.
- Most patients received a low daily dose of 0.0625 mg.
- Serum digoxin concentrations were subtherapeutic in 20 of 32 measured patients (62.5%).
- In patients with atrial fibrillation, eight of 17 (47%) had a ventricular rate exceeding 100 beats per minute.
Conclusions:
- Routine prescribing of very low-dose digoxin in elderly nursing home residents is often inappropriate.
- There is a need for careful review of the indication for maintenance digoxin therapy.
- Current prescribing practices may lead to subtherapeutic levels and suboptimal patient outcomes.
Abstract:
1. The prevalence and circumstance of digoxin prescribing was assessed in five private nursing homes. 2. Forty-one patients (21% residents) were taking digoxin. 3. Seventeen patients were in atrial fibrillation and the remainder in sinus rhythm. The ventricular rate exceeded 100 beats min-1 in eight of the 17 patients in atrial fibrillation. 4. Thirty-seven patients were prescribed 0.0625 mg digoxin daily and serum digoxin concentrations were subtherapeutic in 20 of 32 patients in whom concentrations were measured. 5. These data indicate a need for more careful review of the need for maintenance digoxin and illustrate the inappropriateness of routinely prescribing very low doses in all elderly patients.