Emergency department visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010
Recent data on digoxin prescribing and adverse events are lacking but could help inform the management of digoxin in contemporary heart failure treatment. We determined nationally representative numbers and rates of emergency department (ED) visits for digoxin toxicity in the United States using 200...
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Veröffentlicht in: | Circulation. Heart failure 2014-01, Vol.7 (1), p.28-34 |
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creator | See, Isaac Shehab, Nadine Kegler, Scott R Laskar, S Raja Budnitz, Daniel S |
description | Recent data on digoxin prescribing and adverse events are lacking but could help inform the management of digoxin in contemporary heart failure treatment.
We determined nationally representative numbers and rates of emergency department (ED) visits for digoxin toxicity in the United States using 2005 to 2010 reports from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and the National Ambulatory (and Hospital Ambulatory) Medical Care Surveys. Based on 441 cases, an estimated 5156 (95% confidence interval [CI], 2663-7648) ED visits for digoxin toxicity occurred annually in the United States; more than three fourths (78.8% [95% CI, 73.5%-84.1%]) resulted in hospitalization. Serum digoxin level was ≥2.0 ng/mL for 95.8% (95% CI, 93.2%-98.4%) of estimated ED visits with levels reported (n=251 cases). The rate of ED visits per 10 000 outpatient prescription visits among patients≥85 years was twice that of patients 40 to 84 years (rate ratio, 2.4 [95% CI, 1.2-5.0]); among women, the rate was twice that of men (rate ratio, 2.3 [95% CI, 1.1-4.7]). Digoxin toxicity accounted for an estimated 1.0% (95% CI, 0.6%-1.4%) of ED visits for all adverse drug events among patients≥40 years, but an estimated 3.3% (95% CI, 2.3%-4.4%) of ED visits and 5.9% (95% CI, 4.0%-7.9%) of hospitalizations for all adverse drug events among patients≥85 years. Estimated annual ED visits and hospitalizations remained relatively constant from 2005 to 2010.
Digoxin toxicity is not declining; more careful prescribing to high-risk groups and improved monitoring of serum levels might be needed to reduce morbidity from outpatient digoxin use. |
doi_str_mv | 10.1161/CIRCHEARTFAILURE.113.000784 |
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We determined nationally representative numbers and rates of emergency department (ED) visits for digoxin toxicity in the United States using 2005 to 2010 reports from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and the National Ambulatory (and Hospital Ambulatory) Medical Care Surveys. Based on 441 cases, an estimated 5156 (95% confidence interval [CI], 2663-7648) ED visits for digoxin toxicity occurred annually in the United States; more than three fourths (78.8% [95% CI, 73.5%-84.1%]) resulted in hospitalization. Serum digoxin level was ≥2.0 ng/mL for 95.8% (95% CI, 93.2%-98.4%) of estimated ED visits with levels reported (n=251 cases). The rate of ED visits per 10 000 outpatient prescription visits among patients≥85 years was twice that of patients 40 to 84 years (rate ratio, 2.4 [95% CI, 1.2-5.0]); among women, the rate was twice that of men (rate ratio, 2.3 [95% CI, 1.1-4.7]). Digoxin toxicity accounted for an estimated 1.0% (95% CI, 0.6%-1.4%) of ED visits for all adverse drug events among patients≥40 years, but an estimated 3.3% (95% CI, 2.3%-4.4%) of ED visits and 5.9% (95% CI, 4.0%-7.9%) of hospitalizations for all adverse drug events among patients≥85 years. Estimated annual ED visits and hospitalizations remained relatively constant from 2005 to 2010.
Digoxin toxicity is not declining; more careful prescribing to high-risk groups and improved monitoring of serum levels might be needed to reduce morbidity from outpatient digoxin use.</description><identifier>ISSN: 1941-3289</identifier><identifier>EISSN: 1941-3297</identifier><identifier>DOI: 10.1161/CIRCHEARTFAILURE.113.000784</identifier><identifier>PMID: 24300242</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Age Factors ; Aged ; Aged, 80 and over ; Ambulatory Care - statistics & numerical data ; Ambulatory Care - trends ; Anti-Arrhythmia Agents - adverse effects ; Anti-Arrhythmia Agents - blood ; Anti-Arrhythmia Agents - therapeutic use ; Digoxin - adverse effects ; Digoxin - blood ; Digoxin - therapeutic use ; Disease Management ; Emergency Service, Hospital - statistics & numerical data ; Emergency Service, Hospital - trends ; Female ; Heart Failure - drug therapy ; Heart Failure - epidemiology ; Hospitalization - statistics & numerical data ; Hospitalization - trends ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Sex Factors ; United States - epidemiology</subject><ispartof>Circulation. Heart failure, 2014-01, Vol.7 (1), p.28-34</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c318t-3784bf9836cd795b65a1201de7f02b55440a833ea6b48dd8382ec5bdec1a46d33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24300242$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>See, Isaac</creatorcontrib><creatorcontrib>Shehab, Nadine</creatorcontrib><creatorcontrib>Kegler, Scott R</creatorcontrib><creatorcontrib>Laskar, S Raja</creatorcontrib><creatorcontrib>Budnitz, Daniel S</creatorcontrib><title>Emergency department visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010</title><title>Circulation. Heart failure</title><addtitle>Circ Heart Fail</addtitle><description>Recent data on digoxin prescribing and adverse events are lacking but could help inform the management of digoxin in contemporary heart failure treatment.
We determined nationally representative numbers and rates of emergency department (ED) visits for digoxin toxicity in the United States using 2005 to 2010 reports from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and the National Ambulatory (and Hospital Ambulatory) Medical Care Surveys. Based on 441 cases, an estimated 5156 (95% confidence interval [CI], 2663-7648) ED visits for digoxin toxicity occurred annually in the United States; more than three fourths (78.8% [95% CI, 73.5%-84.1%]) resulted in hospitalization. Serum digoxin level was ≥2.0 ng/mL for 95.8% (95% CI, 93.2%-98.4%) of estimated ED visits with levels reported (n=251 cases). The rate of ED visits per 10 000 outpatient prescription visits among patients≥85 years was twice that of patients 40 to 84 years (rate ratio, 2.4 [95% CI, 1.2-5.0]); among women, the rate was twice that of men (rate ratio, 2.3 [95% CI, 1.1-4.7]). Digoxin toxicity accounted for an estimated 1.0% (95% CI, 0.6%-1.4%) of ED visits for all adverse drug events among patients≥40 years, but an estimated 3.3% (95% CI, 2.3%-4.4%) of ED visits and 5.9% (95% CI, 4.0%-7.9%) of hospitalizations for all adverse drug events among patients≥85 years. Estimated annual ED visits and hospitalizations remained relatively constant from 2005 to 2010.
Digoxin toxicity is not declining; more careful prescribing to high-risk groups and improved monitoring of serum levels might be needed to reduce morbidity from outpatient digoxin use.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ambulatory Care - statistics & numerical data</subject><subject>Ambulatory Care - trends</subject><subject>Anti-Arrhythmia Agents - adverse effects</subject><subject>Anti-Arrhythmia Agents - blood</subject><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>Digoxin - adverse effects</subject><subject>Digoxin - blood</subject><subject>Digoxin - therapeutic use</subject><subject>Disease Management</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Emergency Service, Hospital - trends</subject><subject>Female</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - epidemiology</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitalization - trends</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>United States - epidemiology</subject><issn>1941-3289</issn><issn>1941-3297</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUF1LAzEQDKLYWv0LEvDVq_m8DwWhHFdbKAi1fQ65S66N9O5KEov11xupFvVlZ9lhZncHgBuMhhjH-C6fzvNJMZovxqPpbDkvwpQOEUJJyk5AH2cMR5RkyemxT7MeuHDuFaGYcJ6dgx5hFCHCSB-URaPtSrfVHiq9ldY3uvVwZ5zxDspWwXXntsbLjfmQ3nStg3VnoTKr7t200IdaGb-_h8vWeK3gi5deu1tIEOKBDYjRJTir5cbpq28cgOW4WOSTaPb8NM1Hs6iiOPURDfeXdZbSuFJJxsuYSxzkSic1IiXnjCGZUqplXLJUqZSmRFe8VLrCksWK0gF4PPhu38pGqyo8YuVGbK1ppN2LThrxl2nNWqy6nWBxljDGgsHDwaCynXNW10ctRuIrevE_-jCl4hB9UF__Xn_U_mRNPwHBPINx</recordid><startdate>20140101</startdate><enddate>20140101</enddate><creator>See, Isaac</creator><creator>Shehab, Nadine</creator><creator>Kegler, Scott R</creator><creator>Laskar, S Raja</creator><creator>Budnitz, Daniel S</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20140101</creationdate><title>Emergency department visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010</title><author>See, Isaac ; Shehab, Nadine ; Kegler, Scott R ; Laskar, S Raja ; Budnitz, Daniel S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c318t-3784bf9836cd795b65a1201de7f02b55440a833ea6b48dd8382ec5bdec1a46d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ambulatory Care - statistics & numerical data</topic><topic>Ambulatory Care - trends</topic><topic>Anti-Arrhythmia Agents - adverse effects</topic><topic>Anti-Arrhythmia Agents - blood</topic><topic>Anti-Arrhythmia Agents - therapeutic use</topic><topic>Digoxin - adverse effects</topic><topic>Digoxin - blood</topic><topic>Digoxin - therapeutic use</topic><topic>Disease Management</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Emergency Service, Hospital - trends</topic><topic>Female</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - epidemiology</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitalization - trends</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>See, Isaac</creatorcontrib><creatorcontrib>Shehab, Nadine</creatorcontrib><creatorcontrib>Kegler, Scott R</creatorcontrib><creatorcontrib>Laskar, S Raja</creatorcontrib><creatorcontrib>Budnitz, Daniel S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation. Heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>See, Isaac</au><au>Shehab, Nadine</au><au>Kegler, Scott R</au><au>Laskar, S Raja</au><au>Budnitz, Daniel S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency department visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010</atitle><jtitle>Circulation. Heart failure</jtitle><addtitle>Circ Heart Fail</addtitle><date>2014-01-01</date><risdate>2014</risdate><volume>7</volume><issue>1</issue><spage>28</spage><epage>34</epage><pages>28-34</pages><issn>1941-3289</issn><eissn>1941-3297</eissn><abstract>Recent data on digoxin prescribing and adverse events are lacking but could help inform the management of digoxin in contemporary heart failure treatment.
We determined nationally representative numbers and rates of emergency department (ED) visits for digoxin toxicity in the United States using 2005 to 2010 reports from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and the National Ambulatory (and Hospital Ambulatory) Medical Care Surveys. Based on 441 cases, an estimated 5156 (95% confidence interval [CI], 2663-7648) ED visits for digoxin toxicity occurred annually in the United States; more than three fourths (78.8% [95% CI, 73.5%-84.1%]) resulted in hospitalization. Serum digoxin level was ≥2.0 ng/mL for 95.8% (95% CI, 93.2%-98.4%) of estimated ED visits with levels reported (n=251 cases). The rate of ED visits per 10 000 outpatient prescription visits among patients≥85 years was twice that of patients 40 to 84 years (rate ratio, 2.4 [95% CI, 1.2-5.0]); among women, the rate was twice that of men (rate ratio, 2.3 [95% CI, 1.1-4.7]). Digoxin toxicity accounted for an estimated 1.0% (95% CI, 0.6%-1.4%) of ED visits for all adverse drug events among patients≥40 years, but an estimated 3.3% (95% CI, 2.3%-4.4%) of ED visits and 5.9% (95% CI, 4.0%-7.9%) of hospitalizations for all adverse drug events among patients≥85 years. Estimated annual ED visits and hospitalizations remained relatively constant from 2005 to 2010.
Digoxin toxicity is not declining; more careful prescribing to high-risk groups and improved monitoring of serum levels might be needed to reduce morbidity from outpatient digoxin use.</abstract><cop>United States</cop><pmid>24300242</pmid><doi>10.1161/CIRCHEARTFAILURE.113.000784</doi><tpages>7</tpages></addata></record> |
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source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
subjects | Adult Age Factors Aged Aged, 80 and over Ambulatory Care - statistics & numerical data Ambulatory Care - trends Anti-Arrhythmia Agents - adverse effects Anti-Arrhythmia Agents - blood Anti-Arrhythmia Agents - therapeutic use Digoxin - adverse effects Digoxin - blood Digoxin - therapeutic use Disease Management Emergency Service, Hospital - statistics & numerical data Emergency Service, Hospital - trends Female Heart Failure - drug therapy Heart Failure - epidemiology Hospitalization - statistics & numerical data Hospitalization - trends Humans Male Middle Aged Retrospective Studies Risk Factors Sex Factors United States - epidemiology |
title | Emergency department visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010 |
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