TY - JOUR
T1 - Digoxin Use and Associated Adverse Events Among Older Adults
AU - Angraal, Suveen
AU - Nuti, Sudhakar V.
AU - Masoudi, Frederick A.
AU - Freeman, James V.
AU - Murugiah, Karthik
AU - Shah, Nilay D.
AU - Desai, Nihar R.
AU - Ranasinghe, Isuru
AU - Wang, Yun
AU - Krumholz, Harlan M.
N1 - Funding Information:
Conflict of Interest: HMK was a recipient of a research grant, through Yale, from Medtronic and the US Food and Drug Administration to develop methods for postmarket surveillance of medical devices; was a recipient of a research agreement, through Yale, from the Shenzhen Center for Health Information for work to advance intelligent disease prevention and health promotion, and collaborates with the National Center for Cardiovascular Diseases in Beijing; received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin Law Firm for work related to the Cook IVC filter litigation; chairs a Cardiac Scientific Advisory Board for UnitedHealth; is a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Boards for Element Science and for Facebook, and the Physician Advisory Board for Aetna; and is the founder of Hugo, a personal health information platform. HMK and NRD were recipients of research agreements with Medtronic and Johnson & Johnson (Janssen), through Yale, to develop methods of clinical trial data sharing; and work under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are publicly reported. NRD reports research grants and consulting with Amgen, Boehringer Ingelheim, Novartis, and Relypsa. FAM has a contract with the American College of Cardiology as the Chief Medical Officer of the National Cardiovascular Data Registry. The other authors report no potential conflicts of interest.
Funding Information:
Funding: JVF is supported by grant K23 HL118147-01 from the National Heart, Lung, and Blood Institute. IR is supported by a National Heart Foundation of Australia Future Leader Fellowship (ID 101186). NDS receives research support through the Mayo Clinic from the US Food and Drug Administration to establish the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation program (U01FD005938), from the Centers of Medicare and Medicaid Innovation under the Transforming Clinical Practice Initiative, from the Agency for Healthcare Research and Quality (R01HS025164; R01HS025402; 1U19HS024075; R03HS025517), from the National Heart, Lung, and Blood Institute of the National Institutes of Health (R56HL130496; R01HL131535), National Science Foundation, and from the Patient-Centered Outcomes Research Institute to develop a Clinical Data Research Network. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Funding Information:
Funding: JVF is supported by grant K23 HL118147-01 from the National Heart, Lung, and Blood Institute. IR is supported by a National Heart Foundation of Australia Future Leader Fellowship (ID 101186). NDS receives research support through the Mayo Clinic from the US Food and Drug Administration to establish the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation program (U01FD005938), from the Centers of Medicare and Medicaid Innovation under the Transforming Clinical Practice Initiative, from the Agency for Healthcare Research and Quality (R01HS025164; R01HS025402; 1U19HS024075; R03HS025517), from the National Heart, Lung, and Blood Institute of the National Institutes of Health (R56HL130496; R01HL131535), National Science Foundation, and from the Patient-Centered Outcomes Research Institute to develop a Clinical Data Research Network. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Conflict of Interest: HMK was a recipient of a research grant, through Yale, from Medtronic and the US Food and Drug Administration to develop methods for postmarket surveillance of medical devices; was a recipient of a research agreement, through Yale, from the Shenzhen Center for Health Information for work to advance intelligent disease prevention and health promotion, and collaborates with the National Center for Cardiovascular Diseases in Beijing; received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin Law Firm for work related to the Cook IVC filter litigation; chairs a Cardiac Scientific Advisory Board for UnitedHealth; is a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Boards for Element Science and for Facebook, and the Physician Advisory Board for Aetna; and is the founder of Hugo, a personal health information platform. HMK and NRD were recipients of research agreements with Medtronic and Johnson & Johnson (Janssen), through Yale, to develop methods of clinical trial data sharing; and work under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are publicly reported. NRD reports research grants and consulting with Amgen, Boehringer Ingelheim, Novartis, and Relypsa. FAM has a contract with the American College of Cardiology as the Chief Medical Officer of the National Cardiovascular Data Registry. The other authors report no potential conflicts of interest.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/10
Y1 - 2019/10
N2 - Background: Over the past 2 decades, guidelines for digoxin use have changed significantly. However, little is known about the national-level trends of digoxin use, hospitalizations for toxicity, and subsequent outcomes over this time period. Methods: To describe digoxin prescription trends, we conducted a population-level, cohort study using data from IQVIA, Inc.’s National Prescription Audit (2007-2014) for patients aged ≥ 65 years. Further, in a national cohort of Medicare fee-for-service beneficiaries aged ≥ 65 years in the United States, we assessed temporal trends of hospitalizations associated with digoxin toxicity and the outcomes of these hospitalizations between 1999 and 2013. Results: From 2007 through 2014, the number of digoxin prescriptions dispensed decreased by 46.4%; from 8,099,856 to 4,343,735. From 1999 through 2013, the rate of hospitalizations with a principal or secondary diagnosis of digoxin toxicity decreased from 15 to 2 per 100,000 person-years among Medicare fee-for-service beneficiaries. In-hospital and 30-day mortality rates associated with hospitalization for digoxin toxicity decreased significantly among Medicare fee-for-service beneficiaries; from 6.0% (95% confidence interval [CI], 5.2-6.8) to 3.7% (95% CI, 2.2-5.7) and from 14.0% (95% CI, 13.0-15.2) to 10.1% (95% CI, 7.6-13.0), respectively. Rates of 30-day readmission for digoxin toxicity decreased from 23.5% (95% CI, 22.1-24.9) in 1999 to 21.7% (95% CI, 18.0-25.4) in 2013 (P < .05). Conclusion: While digoxin prescriptions have decreased, it is still widely prescribed. However, the rate of hospitalizations for digoxin toxicity and adverse outcomes associated with these hospitalizations have decreased. These findings reflect the changing clinical practice of digoxin use, aligned with the changes in clinical guidelines.
AB - Background: Over the past 2 decades, guidelines for digoxin use have changed significantly. However, little is known about the national-level trends of digoxin use, hospitalizations for toxicity, and subsequent outcomes over this time period. Methods: To describe digoxin prescription trends, we conducted a population-level, cohort study using data from IQVIA, Inc.’s National Prescription Audit (2007-2014) for patients aged ≥ 65 years. Further, in a national cohort of Medicare fee-for-service beneficiaries aged ≥ 65 years in the United States, we assessed temporal trends of hospitalizations associated with digoxin toxicity and the outcomes of these hospitalizations between 1999 and 2013. Results: From 2007 through 2014, the number of digoxin prescriptions dispensed decreased by 46.4%; from 8,099,856 to 4,343,735. From 1999 through 2013, the rate of hospitalizations with a principal or secondary diagnosis of digoxin toxicity decreased from 15 to 2 per 100,000 person-years among Medicare fee-for-service beneficiaries. In-hospital and 30-day mortality rates associated with hospitalization for digoxin toxicity decreased significantly among Medicare fee-for-service beneficiaries; from 6.0% (95% confidence interval [CI], 5.2-6.8) to 3.7% (95% CI, 2.2-5.7) and from 14.0% (95% CI, 13.0-15.2) to 10.1% (95% CI, 7.6-13.0), respectively. Rates of 30-day readmission for digoxin toxicity decreased from 23.5% (95% CI, 22.1-24.9) in 1999 to 21.7% (95% CI, 18.0-25.4) in 2013 (P < .05). Conclusion: While digoxin prescriptions have decreased, it is still widely prescribed. However, the rate of hospitalizations for digoxin toxicity and adverse outcomes associated with these hospitalizations have decreased. These findings reflect the changing clinical practice of digoxin use, aligned with the changes in clinical guidelines.
KW - Adverse drug event
KW - Atrial fibrillation
KW - Digoxin
KW - Heart failure
KW - Hospitalization
KW - Medicare
KW - Mortality
KW - Prescriptions
KW - Readmission
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U2 - 10.1016/j.amjmed.2019.04.022
DO - 10.1016/j.amjmed.2019.04.022
M3 - Article
C2 - 31077654
AN - SCOPUS:85067236489
SN - 0002-9343
VL - 132
SP - 1191
EP - 1198
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 10
ER -