A newly proposed digoxin dosing method predicted digoxin concentrations more accurately (RMSE 0.375) than the Jelliffe (RMSE 0.810) and Jusko and Koup (RMSE 0.401) methods.
Observational (n=54)
Does a new dosing method based on creatinine clearance and ideal body weight improve the accuracy of predicting steady-state digoxin concentrations in hospitalized heart failure patients compared to existing methods?
A newly proposed dosing method incorporating creatinine clearance and ideal body weight provides more accurate prediction of steady-state digoxin concentrations in heart failure patients compared to older methods.
Absolute Event Rate: 0.375% vs 0.401%
BACKGROUND: The therapeutic range for digoxin in heart failure has recently changed to become lower and narrower, and the new range is associated with improved mortality. However, dosing methods have not been modified to reflect this change. In this study, we sought to develop a new method to determine the initial dose of digoxin in patients with heart failure. METHODS: Over a 6-month period, medical records were screened and reviewed for hospitalized adult patients who had a steady state digoxin concentration. A multiple linear regression was estimated relating digoxin concentration, digoxin dose, creatinine clearance, and ideal body weight to generate an equation relating the dose of digoxin with these variables and a specific target digoxin concentration of 0.7 ng/mL (0.9 nmol/L). This new method was then compared with 2 existing methods. RESULTS: Included in the study were 54 patients (mean SD age, 68 15 years, with a mean (SD) creatinine clearance of 50 (25) mL/min (0.8 0.4 mL/s) and mean (SD) ideal body weight of 62 (11) kg. Our proposed method and the Jusko and Koup method were more accurate than the Jelliffe method in predicting digoxin concentration. Root mean square errors were as follows: for the Jelliffe method (using ideal body weight), 0.810; for the Koup and Jusko method (with heart failure), 0.401; our proposed method, 0.375. The proposed method was then used to create a dosing nomogram. CONCLUSIONS: Because the new therapeutic window of digoxin is associated with improved outcomes, more intensive dosage refinement should be considered. To this end, we offer new dosing recommendations and a nomogram for determining the initial dose of digoxin in patients with heart failure.
Jerry L. Bauman (Mon,) conducted a observational in Heart failure (n=54). Proposed digoxin dosing method vs. Jelliffe method and Jusko and Koup method was evaluated on Accuracy in predicting digoxin concentration (Root mean square error). A newly proposed digoxin dosing method predicted digoxin concentrations more accurately (RMSE 0.375) than the Jelliffe (RMSE 0.810) and Jusko and Koup (RMSE 0.401) methods.