Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes
Por:
Mojarro, EM, Gil, V, Llorens, P, Alvarez, J, Quesada, SF, Ungerer, OJT, Alquezar-Arbé, A, Jacob, J, Herrero-Puente, P, Espinosa, B, Sánchez, C, Llauger, L, Tost, J, Serrano, L, Dávila, A, Garate, RT, López-Grima, ML, Lucas-Imbernón, FJ, Alonso, H, Pagán, F, Garrido, JM, Miró, O
Publicada:
1 dic 2023
Resumen:
Objectives. To analyze factors related to the use of digoxin to treat patients with acute heart failure (AHF) in emergency departments (EDs) and the impact of digoxin treatment on short-term outcomes.
Methods. We included patients diagnosed with AHF in 45 Spanish EDs. The patients, who were not undergoing long-term treatment for heart failure, were classified according to whether or not they were given intravenous digoxin in the ED. Fifty-one patient or cardiac decompensation episode variables were recorded to profile ED patients treated with digoxin. Outcome variables studied were the need for hospital admission, prolonged stay in the ED (> 24 hours) for discharged patients, prolonged hospitalization (> 7 days) for admitted patients, and all-cause in-hospital or 30-day mortality. The associations between digoxin treatment and the outcomes were studied with odds ratios (ORs) adjusted for patient and AHF episode characteristics.
Results. Data for 15 549 patients (median age, 83 years; 55% women) were analyzed; 1430 (9.2%) were treated with digoxin. Digoxin was used more often in women, young patients, and those with better New York Heart Association (NYHA) classifications but more severe cardiac decompensation, especially if the trigger was atrial fibrillation with rapid ventricular response. Admissions were ordered for 75.4% of the patients overall (81.6% of digoxin-treated patients vs 74.8% of nontreated patients; P < .001). The ED stay was prolonged in 38.3% of patients discharged from the ED (52.9% of digoxin-treated patients vs 37.2% of nontreated patients; P < .001). The duration of hospital stay was prolonged in 48.1% (digoxin-treated, 49.3% vs 47.9%; P = .385). In-hospital mortality was 7.2% overall (6.9% vs 7.2%, P= .712), and 30-day mortality was 9.7% (9.3% vs 9.7%, P = .625). ED use of digoxin was associated with a prolonged stay in the department (adjusted OR, 1.883; 95% CI, 1.359-2.608) but not with hospitalization or mortality.
Conclusions. Digoxin continues to be used in one out of ten ED patients who are not already on long-term treatment with the drug. Digoxin use is associated with cardiac decompensation triggered by atrial fibrillation with rapid ventricular response, younger age, women, and patients with better initial NYHA function status but possibly more severe decompensation. Digoxin use leads to a longer ED stay but is safe, as it is not associated with need for admission, prolonged hospitalization, or short-term mortality.
Filiaciones:
Mojarro, EM:
Hosp St Pau & Santa Tecla, Serv Urgencias, Tarragona, Spain
Gil, V:
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, Area Urgencias, Barcelona, Spain
Llorens, P:
Univ Miguel Hernandez, Inst Invest Sanitaria & Biomed Alicante ISABIA, Hosp Gen Dr Balmis, Serv Urgencias Corta Estancia Hosp Domicilio, Alicante, Spain
Alvarez, J:
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, Area Urgencias, Barcelona, Spain
Quesada, SF:
Hosp St Pau & Santa Tecla, Serv Urgencias, Tarragona, Spain
Ungerer, OJT:
Hosp St Pau & Santa Tecla, Serv Urgencias, Tarragona, Spain
Alquezar-Arbé, A:
Hosp Santa Creu & Sant Pau, Serv Urgencias, Barcelona, Spain
Jacob, J:
Hosp Univ Bellvitge, Serv Urgencias, Lhospitalet De Llobregat, Barcelona, Spain
Herrero-Puente, P:
Hosp Univ Cent Asturias, Inst Invest Biosanitaria Principado Asturias ISPA, Serv Urgencias, Oviedo, Spain
Espinosa, B:
Univ Miguel Hernandez, Inst Invest Sanitaria & Biomed Alicante ISABIA, Hosp Gen Dr Balmis, Serv Urgencias Corta Estancia Hosp Domicilio, Alicante, Spain
Sánchez, C:
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, Area Urgencias, Barcelona, Spain
Llauger, L:
Univ Vic, Cent Catalunya UVIC UCC, Inst Recerca Innovacio Ciencies Vida Salut Catalu, Althaia Xarxa Assistencial Univ Manresa,Serv Urge, Barcelona, Spain
Tost, J:
Consorci Hosp Terrassa, Serv Urgencias, Barcelona, Spain
Serrano, L:
Hosp Politecn La Fe, Serv Urgencias, Valencia, Spain
Dávila, A:
Hosp Univ Salamanca, Serv Urgencias, Salamanca, Spain
Garate, RT:
Hosp Severo Ochoa, Serv Urgencias, Madrid, Spain
López-Grima, ML:
Hosp Dr Peset, Serv Urgencias, Valencia, Spain
Lucas-Imbernón, FJ:
Hosp Gen Univ Albacete, Serv Urgencias, Albacete, Spain
Alonso, H:
Hosp Marques Valdecilla, Serv Urgencias, Santander, Spain
Pagán, F:
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, Area Urgencias, Barcelona, Spain
Garrido, JM:
Hosp Virgen Macarena, Serv Urgencias, Seville, Spain
Miró, O:
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, Area Urgencias, Barcelona, Spain
Open Access
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