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[The characteristics of digoxin utilization in a population under emergency care for heart failure or auricular
Insights
Many patients with heart failure and atrial fibrillation presenting to the emergency department have poorly controlled digoxin levels, with significant non-adherence to treatment. This highlights issues in primary care management of digoxin therapy.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Context:
- Observational study in a hospital emergency department.
- Focus on patients with heart failure or atrial fibrillation treated with digoxin.
- 3-month study duration.
Purpose:
- To investigate the characteristics of digoxin use in emergency department patients.
- To assess digoxin control and treatment adherence.
- To identify factors related to digoxin levels.
Summary:
- 50% of patients showed inadequate digoxin control; 21% had poor treatment adherence.
- Digoxin levels correlated with dosage, heart rate, and patient compliance.
- One-third of patients with unexplained cardiac decompensation had subtherapeutic digoxin levels.
Impact:
- Suggests inadequate management in primary care contributes to emergency visits for cardiac decompensation.
- Highlights the need for improved patient education and monitoring of digoxin therapy.
- Identifies subtherapeutic digoxin levels as a potential cause for unexplained decompensation.
Background:
With the aim of studying the characteristics of the use of digoxin in a population which attended a hospital emergency department for heart failure or auricular fibrillation a 3 month observational study was carried out in the emergency department of the Ciudad Sanitaria de la Vall d'Hebron.
Methods:
One hundred twelve patients treated with digoxin who went to the emergency department for heart failure and/or decompensated auricular fibrillation were studied. Clinical and pharmacological histories, determination of digoxinemia and the usual complementary explorations were performed.
Results:
It was found that 50% of the patients were not adequately controlled and treatment was not followed in 21% of the patients. No significant relation was found between the doses of digoxin and the age of the patients. In multivariant analysis (multiple lineal regression) digoxinemia was related with the doses (beta = 0.22, p = 0.01), cardiac frequency (beta = 0.19, p < 0.05), and compliance (beta = 0.18, p = 0.05). Among the patients in whom the cause of decompensation of cardiac failure could not be identified, one third (31%) were found to have infratherapeutic digoxinemia.
Conclusions:
Most patients with cardiac decompensation attending an emergency department are those who are not adequately controlled in primary health care and the rate of incomplete following of the prescription is high. Furthermore, one third of the patients who decompensate with no clinically apparent reason has an infratherapeutic plasma concentration of digoxin.