Digoxin Toxicity and Use of Digoxin Immune Fab. Insights From a National Hospital Database.

Paul Hauptman, Steven W. Blume, Eldrin F. Lewis, Suzanne Ward

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objectives: This study was developed to determine contemporary management of digoxin toxicity and clinical outcomes. Background: Although the use of digoxin in heart failure management has declined, toxicity remains a prevalent complication. Methods: The Premier Perspective Comparative Hospital Database (Premier Inc., Charlotte, North Carolina) was used to retrospectively identify patients diagnosed with digoxin toxicity and/or who received digoxin immune fab (DIF) over a 5-year period (2007 to 2011). DIF was evaluated using treatment date, number of vials administered, and total cost. Clinical outcomes included length of stay (total hospitalization; days after DIF), cost of hospitalization, and in-hospital mortality. Exploratory multivariate analyses were conducted to determine predictors of DIF and effect on length of stay, adjusting for patient characteristics and selection bias. Results: Digoxin toxicity diagnosis without DIF treatment accounted for 19,543 cases; 5,004 patients received DIF of whom 3086 had a diagnosis of toxicity. Most patients were >65 years old (88%). The predictors of DIF use were urgent/emergent admission, hyperkalemia, arrhythmia associated with digoxin toxicity, acute renal failure, or suicidal intent (odds ratios 1.7, 2.4, 3.6, 2.1, and 3.7, respectively; p < 0.0001 for all). The majority (78%) of DIF was administered on days 1 and 2 of the hospitalization; 10% received treatment after day 7. Digoxin was used after DIF administration in 14% of cases. Among patients who received DIF within 2 days of admission, there was no difference for in-hospital mortality or length of stay compared with patients not receiving DIF. Conclusions: Digoxin toxicity diagnoses are clustered in the elderly. One-fifth of cases receive treatment with DIF, most within 2 days of admission. Opportunities exist for improved diagnosis and post-DIF management. Prospective data may be required to assess the impact of DIF on length of stay.

Original languageEnglish (US)
Pages (from-to)357-364
Number of pages8
JournalJACC: Heart Failure
Volume4
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

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Digoxin
Databases
Length of Stay
Hospitalization
Hospital Mortality
digoxin antibodies Fab fragments
Costs and Cost Analysis
Hyperkalemia
Selection Bias
Therapeutics
Acute Kidney Injury
Patient Selection
Cardiac Arrhythmias
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Digoxin Toxicity and Use of Digoxin Immune Fab. Insights From a National Hospital Database. / Hauptman, Paul; Blume, Steven W.; Lewis, Eldrin F.; Ward, Suzanne.

In: JACC: Heart Failure, Vol. 4, No. 5, 01.05.2016, p. 357-364.

Research output: Contribution to journalArticle

Hauptman, Paul ; Blume, Steven W. ; Lewis, Eldrin F. ; Ward, Suzanne. / Digoxin Toxicity and Use of Digoxin Immune Fab. Insights From a National Hospital Database. In: JACC: Heart Failure. 2016 ; Vol. 4, No. 5. pp. 357-364.
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abstract = "Objectives: This study was developed to determine contemporary management of digoxin toxicity and clinical outcomes. Background: Although the use of digoxin in heart failure management has declined, toxicity remains a prevalent complication. Methods: The Premier Perspective Comparative Hospital Database (Premier Inc., Charlotte, North Carolina) was used to retrospectively identify patients diagnosed with digoxin toxicity and/or who received digoxin immune fab (DIF) over a 5-year period (2007 to 2011). DIF was evaluated using treatment date, number of vials administered, and total cost. Clinical outcomes included length of stay (total hospitalization; days after DIF), cost of hospitalization, and in-hospital mortality. Exploratory multivariate analyses were conducted to determine predictors of DIF and effect on length of stay, adjusting for patient characteristics and selection bias. Results: Digoxin toxicity diagnosis without DIF treatment accounted for 19,543 cases; 5,004 patients received DIF of whom 3086 had a diagnosis of toxicity. Most patients were >65 years old (88{\%}). The predictors of DIF use were urgent/emergent admission, hyperkalemia, arrhythmia associated with digoxin toxicity, acute renal failure, or suicidal intent (odds ratios 1.7, 2.4, 3.6, 2.1, and 3.7, respectively; p < 0.0001 for all). The majority (78{\%}) of DIF was administered on days 1 and 2 of the hospitalization; 10{\%} received treatment after day 7. Digoxin was used after DIF administration in 14{\%} of cases. Among patients who received DIF within 2 days of admission, there was no difference for in-hospital mortality or length of stay compared with patients not receiving DIF. Conclusions: Digoxin toxicity diagnoses are clustered in the elderly. One-fifth of cases receive treatment with DIF, most within 2 days of admission. Opportunities exist for improved diagnosis and post-DIF management. Prospective data may be required to assess the impact of DIF on length of stay.",
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