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Reassessment of indications for digoxin. Are patients being withdrawn?
C A Sueta1, T S Carey, C K Burnett
1Department of Medicine, University of North Carolina, Chapel Hill 27599.
Insights
Many patients on digoxin can be safely withdrawn from the medication. A study found that reassessment of need led to successful digoxin withdrawal in many patients, with most remaining stable.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Digoxin is a common medication for heart conditions.
- Previous studies suggest many patients can discontinue digoxin therapy.
- The practical application of digoxin withdrawal in outpatient settings requires investigation.
Purpose of the Study:
- To determine the rate of digoxin withdrawal in an outpatient population.
- To identify factors influencing successful digoxin discontinuation.
- To assess patient stability after digoxin withdrawal.
Main Methods:
- A retrospective medical record review of 163 outpatients treated with digoxin.
- Analysis of original indications for digoxin therapy.
- Tracking of digoxin withdrawal and patient stability over a 3.5-year period.
- Statistical analysis to identify predictors of withdrawal.
Main Results:
- One-third of patients were withdrawn from digoxin during the study period.
- 79% of withdrawn patients remained stable without digoxin.
- Reassessment of the need for digoxin was the strongest predictor of withdrawal.
- 68% of patients underwent reassessment, with nearly half being withdrawn.
Conclusions:
- Physicians are actively reassessing digoxin necessity, leading to higher withdrawal rates.
- Successful digoxin withdrawal is achievable, particularly for patients with unclear initial indications or without current evidence of heart failure or tachycardia.
- Patients can often be safely taken off digoxin, especially when their need for the medication is re-evaluated.
Abstract:
Several studies have shown that the majority of patients receiving digoxin can be successfully withdrawn. A medical record review was conducted to determine whether, in practice, patients were being withdrawn from digoxin. Original indications for digoxin therapy in 163 outpatients were as follows: congestive heart failure (CHF), 50%; supraventricular tachycardia (SVT), 23%; CHF and SVT, 10%; and unknown/unclear, 17%. One third of these patients were withdrawn during the 3.5-year study, and 79% remained stable, off digoxin. The most significant predictor of withdrawal was chart indication of reassessment of the need for digoxin. The majority of the patients (68%) were reassessed, and of these, almost half were withdrawn. Physicians appear to be reassessing the need for digoxin therapy, resulting in higher withdrawal rates than previously reported. Results suggest that patients with unclear original indications, a onetime indication, or without clinical evidence of CHF or SVT can be successfully withdrawn.