November 1, 2009American Journal of Therapeutics

Prevalence of Inappropriate Use of Digoxin in 136 Patients on Digoxin and Prevalence of Use of Warfarin or Aspirin in 89 Patients With Persistent or Paroxysmal Atrial Fibrillation

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Structured PICO

Population

136 patients receiving digoxin in the hospital or medical clinic (mean age 72 years, 35% HFrEF, 60% persistent AF, 5% paroxysmal AF) and 89 patients with persistent or paroxysmal AF.

Intervention

Digoxin therapy; Warfarin or aspirin therapy

Outcome

Prevalence of inappropriate use of digoxin and prevalence of nonuse of warfarin or aspirin

In this cohort, inappropriate use of digoxin and underuse of antithrombotic therapy in atrial fibrillation were both low, indicating high adherence to appropriate prescribing practices.

Implication

Indicates high adherence to appropriate AF prescribing in this cohort; leaves open generalizability beyond this cross-sectional sample.

Abstract

Of 136 patients, mean age 72 years, receiving digoxin in the hospital or in the medical clinic, 47 (35%) had heart failure with reduced left ventricular ejection fraction and symptoms despite optimal medical therapy, 82 (60%) had persistent atrial fibrillation (AF), and 7 (5%) had paroxysmal AF. The prevalence of inappropriate use of digoxin was 5%. Of 89 patients with persistent or paroxysmal AF, 70 (79%) were being treated with warfarin to maintain an International Normalized Ratio between 2.0 and 3.0, 15 (17%) were being treated with aspirin 325 mg daily, and 4 (4%) were not being treated with warfarin or aspirin. The prevalence of nonuse of warfarin or aspirin in patients with persistent or paroxysmal AF was 4%.