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Prevalence of Appropriate and Inappropriate Indications for Use of Digoxin in Older Patients at the Time of Admission to a Nursing Home
Author(s) -
Aronow Wilbert S.
Publication year - 1996
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1996.tb01448.x
Subject(s) - digoxin , medicine , atrial fibrillation , sinus rhythm , ejection fraction , heart failure , cardiology , emergency medicine
OBJECTIVE : To investigate the prevalence of digoxin use and appropriate and inappropriate indications for digoxin use in older patients at the time of admission to a nursing home. DESIGN : In a prospective study of 500 consecutive patients aged 60 years of age or older admitted to a nursing home, 96 (19%) patients were receiving digoxin at the time of admission to the nursing home. Appropriate and inappropriate indications for digoxin use were investigated in these 96 patients. SETTING : A large, long‐term health care facility where 500 consecutive older patients were studied. PATIENTS : The 500 patients included 344 women and 156 men, mean age 81 ± 8 years (range 60–100). MEASUREMENTS AND MAIN RESULTS : Ninety‐six of the 500 patients (19%) were receiving digoxin at the time of admission to the nursing home. Fifty‐one (53%) of the 96 patients receiving digoxin had an appropriate indication for digoxin use, and 45 (47%) had an inappropriate indication for digoxin use. Appropriate indications for digoxin use included atrial fibrillation with or without congestive heart failure (CHF) in 35 patients (36%) and CHF with sinus rhythm and abnormal left ventricular (LV) ejection fraction in 16 patients (17%). Inappropriate indications for digoxin use included CHF with sinus rhythm and normal LV ejection fraction in 18 patients (19%), misdiagnosis of edema or dyspnea as CHF in patients with sinus rhythm and normal LV ejection fraction in 17 patients (18%), history of possible (undocumented) paroxysmal atrial fibrillation in nine patients (9%), and sinus tachycardia in one patient (1%). Two of the 45 patients (5%) inappropriately treated with digoxin had evidence of digitalis toxicity on their admission electrocardiogram. CONCLUSIONS : The prevalence of digoxin use was 19% in older patients at the time of admission to the nursing home. Almost half of patients (47%) receiving digoxin at the time of admission had an inappropriate indication for digoxin use at that time.