Emergency Department Visits and Hospitalizations for Digoxin Toxicity United States, 2005 to 2010

• Type of Material: Article
• Authors: Isaac See, Centers for Disease Control and Prevention; Nadine Shehab, Centers for Disease Control and Prevention; Scott R. Kegler, Centers for Disease Control and Prevention; Sonjoy Laskar, Emory University; Daniel Budnitz, Emory University
• Language: English
• Date: 2014-01-01
• Publisher: AHA Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCHEARTFAILURE.113.000784
• Title of Journal or Parent Work: Circulation: Heart Failure
• Volume: 7
• Issue: 1
• Start Page: 28
• End Page: 34
• Grant/Funding Information: Centers for Disease Control and Prevention
• Keywords: Risk; Heart failure; Science & Technology; Drug; Hospital; Cardiac & Cardiovascular Systems; Morbidity; Digitalis; Surveillance; Emergency service; Mortality; Dig trial; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; Digoxin; Drug-related side effects and adverse reactions; Hospitalization; Investigation group trial
• Research Categories: Health Sciences, Pharmacy; Health Sciences, Rehabilitation and Therapy; Health Sciences, Health Care Management

Abstract

Background: Recent data on digoxin prescribing and adverse events are lacking but could help inform the management of digoxin in contemporary heart failure treatment. Methods and Results: 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. Conclusions: 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.