Key result
Digoxin therapy in heart failure shows no significant rehospitalization benefit despite a ~28% intoxication rate.
Why the study?
Digoxin remains controversial due to its narrow safety margin, and analysis of digoxin intoxication had never been reported in Indonesia.
What is the rate of digoxin intoxication, rehospitalization, and one-year survival in heart failure patients receiving digoxin?
Cross-Sectional (n=195)
No
What is the rate of digoxin intoxication, rehospitalization, and one-year survival in heart failure patients receiving digoxin?
Absolute Event Rate: 11.8% vs 29.2%
p-value: p=0.085
Digoxin intoxication is common (27.69%) among heart failure patients receiving the drug, particularly those with renal insufficiency, though digoxin use showed a non-significant trend toward reduced one-year rehospitalization.
High digoxin intoxication risk in HF, especially with renal impairment, warrants monitoring; leaves open rehospitalization benefit amid weak consensus against use.
BACKGROUND: Despite being the oldest therapy for heart failure, the use of digoxin is still controversial due to the narrow margin of safety. In Indonesia, digoxin is still considered one of the treatments for heart failure. However, analysis of intoxication has never been reported. This study aims to analyze the occurrence of digoxin intoxication, rate of rehospitalization and one-year survival in heart failure patients under digoxin treatment. METHODS: A cross section-observational study was conducted at Harapan Kita National Cardiovascular Centre from January 2017 to December 2018 on heart failure patients who received digoxin therapy and had data on serum digoxin level. Intoxication was defined as the presence of specific ECG alteration(s), at least one extra-cardiac symptom(s) and further classified as definite (serum digoxin >2 ng/mL), probable (serum digoxin 0.91-1.99 ng/mL), or possible (serum digoxin 0.5-0.9 ng/mL). Risk factors of intoxication were analyzed by Chi-square test, and one-year survival was analyzed with Kaplan Meyer method. RESULTS: 54 of 195 patients (27.69%) were classified as having intoxication, consisting of 32 (16.41%) definite, 19 (9.74%) probable, and 3 (1.54%) possible. Renal insufficiency was revealed as a significant influencing factor of digoxin intoxication with RR 2.48 (CI 1.13-5.464, p=0.016). Overall one-year survival of patients receiving digoxin was 259 days in the intoxication group and 307 days in the non-intoxication group. One-year rehospitalization was 11.8% in patients who received digoxin and 29.2% in those without digoxin (p=0.085). CONCLUSION: The proportion of digoxin intoxication in heart failure patients was 27.69%. Renal insufficiency was revealed as a significant influencing factor of intoxication. There was a tendency of reduced hospitalization in those who received digoxin.
No takes yet. Share an insight, caveat, or question.
Nafrialdi et al. (2022) conducted a cross-sectional in Heart failure (n=195). Digoxin vs. Without digoxin was evaluated on One-year rehospitalization (p=0.085). Digoxin therapy in heart failure patients was associated with a 27.7% rate of intoxication and a one-year rehospitalization rate of 11.8% compared to 29.2% in those without digoxin (p=0.085).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: