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[Long-term digitalis therapy of elderly patients. Is digitalization unnecessary in the majority of cases?]
Insights
Discontinuing long-term digoxin therapy in elderly patients with stable cardiac insufficiency was safe for 86%. This suggests a more cautious approach to digitalis use in this population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Pharmacology
Context:
- Over 40% of hospitalized patients are on long-term digitalis therapy.
- Elderly patients with stable cardiac insufficiency (NYHA class I-III) and sinus rhythm were studied.
- Digoxin therapy was discontinued during hospitalization for monitoring.
Purpose:
- To assess the safety and efficacy of discontinuing long-term digoxin therapy in elderly patients.
- To monitor clinical outcomes and physiological parameters after digoxin cessation.
- To determine the rate of readmission to digitalis therapy and its indications.
Summary:
- Long-term digoxin was stopped in 97 elderly patients; 86% tolerated discontinuation without adverse effects.
- Key parameters like body weight and heart size remained stable, though pre-ejection period increased.
- Only 14% of those restarted on digoxin had an absolute indication, suggesting overuse.
Impact:
- Recommends cautious use of long-term digitalis therapy in elderly patients.
- Suggests controlled discontinuation trials for digitalized patients in sinus rhythm.
- Highlights potential for reducing unnecessary digitalis prescriptions and associated risks.
Abstract:
More than 40% of patients hospitalized in the Wald Altitude Clinic of Zürich are already on long-term digitalis therapy upon admission. During a 6 month period long-term digoxin therapy was discontinued in 97 patients (age 74 +/- 9 years) with stable cardiac insufficiency (NYHA class I-III) and sinus rhythm. During the hospitalization (37 +/- 20 days), clinical signs and symptoms, body weight, radiological heart size, and systolic time intervals were monitored. After an observation period of one week, digoxin was discontinued in all patients. Body weight, cardio-thoracic ratio and left ventricular ejection time remained unchanged after cessation of digoxin therapy during hospitalization. The pre-ejection period showed a significant increase from 89 +/- 17 to 95 +/- 19 msec. Six patients were re-instituted on digoxin therapy, 3 due to progressive cardiac insufficiency, 2 due to atrial fibrillation, and 1 at his own request. After telephone follow-up six months later with the family physician an additional 20 patients were put back on digitalis. Among the total of 26 patients requiring further digitalization an absolute indication was found only in 12 (14%), 8 due to progressive cardiac insufficiency and 4 due to atrial fibrillation. In this study digitalis therapy could be discontinued without ill effects in 86% of elderly clinically stable patients in sinus rhythm. The authors therefore recommend a more cautious use of long-term digitalis therapy and, in already digitalized patients in sinus rhythm, a controlled trial period of discontinuation.