Article

Increased risk of digoxin toxicity following hospitalization

Center for Education and Research on Therapeutics, Department of Biostatistics and Epidemiology and School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Pharmacoepidemiology and Drug Safety (Impact Factor: 3.17). 01/2009; 18(1):28 - 35. DOI: 10.1002/pds.1680

ABSTRACT PurposeAdverse drug events (ADEs) are an important cause of preventable hospitalizations among elderly individuals taking high-risk medications. The objective of the study was to identify health care system factors that affect the risk of digoxin toxicity for older adults on digoxin.Methods
We conducted a prospective cohort study of older adults within the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program, which provides comprehensive drug benefits for older adults with low income. Subjects were interviewed at the time of enrollment regarding the management and coordination of their health care as well as medication comprehension. Hospitalizations were identified by linking patient identifiers to a state-wide registry. Trained abstractors reviewed discharge summaries of possible digoxin related ADEs. Unadjusted and adjusted incidence rate ratios (IRR) were calculated based on person–months of exposure using Poisson regression models, with variances adjusted for within subject repeated measures.ResultsWe enrolled a total of 2030 adults on digoxin from May 2002 to June 2003. A total of 34 hospitalizations due to digoxin toxicity occurred, equivalent to 1.12 hospitalizations per 1000 person–months of exposure. Adjusting for hospitalization in the past 2 months, age, total number physicians prescribing any medications in past 3 months, total number of pharmacies filling medications in past 3 months, and number of unique prescriptions filled in the past month had a 4.25-fold increased risk of subsequently experiencing digoxin toxicity (IRR 95%CI 1.95, 9.27).Conclusions
The risk of digoxin toxicity-related hospitalization, while low, is higher in the post-hospital period. Copyright © 2008 John Wiley & Sons, Ltd.

0 Followers
 · 
73 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: agents administered during hospi- talization at a tertiary care acade- mic medical center. The retrospec- tive analysis was conducted over 1 year. A total of 416 allergies were reported among 300 patients; more than 1 allergy was reported by more than one-fourth of study patients (82/300 (27.3%)). Only 36.3% (151/416) of allergies reported were accompanied by a reaction description (95% confi- dence interval (CI), 31.7% to
  • Clinical Pharmacology &#38 Therapeutics 02/2009; 85(2):143-4; author reply 144. DOI:10.1038/clpt.2008.252 · 7.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Evidence-based guidelines do not exist for the treatment of patients with chronic mild-moderate digoxin toxicity. We sought to evaluate differences among specialists in the use of digoxin-specific antibody fragments and the decision to admit these patients. A sample of cardiologists, emergency physicians, and medical toxicologists was surveyed. The survey detailed four hypothetical cases of chronic digoxin toxicity created by consensus among authors. All cases had the same digoxin concentration, but signs and symptoms varied in an attempt to explore four different thresholds. For each scenario, clinicians made decisions about admission and treatment. Survey response varied: cardiologists 17%, emergency physicians 6.7%, and toxicologists 39%. Statistically significant difference was found in the administration of Fab among cardiologists (67%), emergency physicians (82%), or toxicologists (91.5%) and admission rate (cardiologists 34%, emergency physicians 28%, and toxicologists 46%). Differences exist among clinicians of various specialties regarding treatment of chronic digoxin toxicity. These differences may reflect diverse perspectives or knowledge gaps and may translate into excess cost or less than ideal care. Exploring these differences may improve patient care, improve interactions among providers, and set the stage for development of consensus guidelines and research.
    Human & Experimental Toxicology 05/2009; 28(5):285-92. DOI:10.1177/0960327109105405 · 1.41 Impact Factor