@article{ref1,
title="Emergency Department Visits and Hospitalizations for Digoxin Toxicity: United States, 2005-2010",
journal="Circulation. Heart failure",
year="2014",
author="See, Isaac and Shehab, Nadine and Kegler, Scott R. and Laskar, S. Raja and Budnitz, Daniel S.",
volume="7",
number="1",
pages="28-34",
abstract="BACKGROUND: -Recent data on digoxin prescribing and adverse events are lacking but could help inform the management of digoxin in contemporary heart failure treatment.   METHODS AND RESULTS: -We determined nationally-representative numbers and rates of emergency department (ED) visits for digoxin toxicity in the United States using 2005-2010 reports from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and the National Ambulatory (and Hospital Ambulatory) Medical Care Surveys. Based on 441 cases, an estimated 5,156 (95% confidence interval [CI], 2,663-7,648) ED visits for digoxin toxicity occurred annually in the United States; over three-fourths (78.8% [95% CI, 73.5%-84.1%]) resulted in hospitalization. Serum digoxin level was ≥2.0 ng/mL for 95.8% (95% CI, 93.2%-98.4%) of estimated ED visits with levels reported (n=251 cases). The rate of ED visits per 10,000 outpatient prescription visits among patients ≥85 years was twice that of patients 40-84 years (rate ratio, 2.4 [95% CI, 1.2-5.0]); among females, the rate was twice that of males (rate ratio, 2.3 [95% CI, 1.1-4.7]). Digoxin toxicity accounted for an estimated 1.0% (95% CI, 0.6%-1.4%) of ED visits for all adverse drug events (ADEs) among patients ≥40 years, but an estimated 3.3% (95% CI, 2.3%-4.4%) of ED visits and 5.9% (95% CI, 4.0%-7.9%) of hospitalizations for all ADEs among patients ≥85 years. Estimated annual ED visits and hospitalizations remained relatively constant from 2005-2010.   CONCLUSIONS: Digoxin toxicity is not declining; more careful prescribing to high-risk groups and improved monitoring of serum levels might be needed to reduce morbidity from outpatient digoxin use.<p /> <p>Language: en</p>",
language="en",
issn="1941-3289",
doi="10.1161/CIRCHEARTFAILURE.113.000784",
url="http://dx.doi.org/10.1161/CIRCHEARTFAILURE.113.000784"
}