JAMDA
Volume 7, Issue 9 , Pages 581-586 , November 2006

Controversy in Heart Failure Management: Digoxin Use in the Elderly

  • Jeremy Chun, MD

      Affiliations

    • UCLA School of Medicine, Multicampus Program in Geriatrics and Gerontology, Los Angeles, CA
  • ,
  • Joshua Chodosh, MD, MSHS

      Affiliations

    • Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
    • Corresponding Author InformationAddress correspondence to Joshua Chodosh, MD, MSHS, VA GLAHS GRECC (11G), 11301 Wilshire Boulevard, Los Angeles, CA 90073.

References 

  1. American Heart Association. Heart Disease and Stroke Statistics (2006 Update). Dallas, TX: American Heart Association; 2006;
  2. Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J. 1991;121:951–957
  3. Avorn J, Gurwitz JH. Drug use in the nursing home. Arch Intern Med. 1995;123:195–204
  4. Tobias DE, Sey M. General and psychotherapeutic medication use in 328 nursing facilities: A year 2000 national survey. Consult Pharm. 2001;16:54–64
  5. Massie BM, Shah NB. Evolving trends in the epidemiologic factors of heart failure: Rationale for preventive strategies and comprehensive disease management. Am Heart J. 1997;133:703–712
  6. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348:2007–2018
  7. Dec GW. Digoxin remains useful in the management of chronic heart failure. Med Clin North Am. 2003;87:317–337
  8. Prystowsky EN, Benson DW, Fuster V, et al. Management of patients with atrial fibrillation (A statement for healthcare professionals. From the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association). Circulation. 1996;93:1262–1277
  9. Hood WB, Dans AL, Guyatt GH, Jaeschke R, McMurray JJV. Digitalis for treatment of congestive heart failure in patients in sinus rhythm. Cochrane Database Syst Rev. 2004;2:CD002901
  10. Tresch DD, McGough MF. Heart failure with normal systolic function: A common disorder in older people. J Am Geriatr Soc. 1995;43:1035–1042
  11. Boxer R, Yang SX, Hager WD. Congestive heart failure and the elderly. Conn Med. 2003;67:497–503
  12. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005;46:e1–e82
  13. The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525–533
  14. Rich MW, McSherry F, Williford WO, Yusuf S Digitalis Investigation Group. Effect of age on mortality, hospitalizations and response to digoxin in patients with heart failure: The DIG study. J Am Coll Cardiol. 2001;38:806–813
  15. Uretsky BF, Young JB, Shahidi FE, Yellen LG, Harrison MC, Jolly MK PROVED Investigative Group. Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: Results of the PROVED trial. J Am Coll Cardiol. 1993;22:955–962
  16. Packer M, Gheorghiade M, Young JB, et al. Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors (RADIANCE Study). N Engl J Med. 1993;329:1–7
  17. Rathore SS, Wang Y, Krumholz HM. Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med. 2002;347:1403–1411
  18. Ahmed A, Aronow WS, Fleg JL. Predictors of mortality and hospitalization in women with heart failure in the Digitalis Investigation Group trial. Am J Ther. 2006;13:325–331
  19. Adams KF, Patterson JH, Gattis WA, et al. Relationship of serum digoxin concentration to mortality and morbidity in women in the Digitalis Investigation Group trial: a retrospective analysis. J Am Coll Cardiol. 2005;46:497–504
  20. Ahmed A, Aban IB, Weaver MT, Aronow WS, Fleg JL. Serum digoxin concentration and outcomes in women with heart failure: A bi-directional effect and a possible effect modification by ejection fraction. Eur J Heart Fail. 2006;8:409–419Epub Nov 28, 2005
  21. El-Salawy SM, Lowenthal DT, Ippagunta S, Bhinder F. Clinical Pharmacology and Physiology Conference: Digoxin toxicity in the elderly. Int Urol Nephrol. 2005;37:665–668
  22. Aronow WS. Treatment of systolic and diastolic heart failure in the elderly. J Am Med Dir Assoc. 2006;7:29–36Epub Oct 24, 2005
  23. Eisendrath SJ, Sweeney MA. Toxic neuropsychiatric effects of digoxin at therapeutic serum concentrations. Am J Psychiatry. 1987;144:506–507
  24. Dimant J, Merrit W. Serum digoxin levels in elderly nursing home patients: Appraisal of routine periodic measurements. J Am Geriatr Soc. 1978;26:378–379
  25. Adams KF, Gheorghiade M, Uretsky BF, Patterson JH, Schwartz TA, Young JB. Clinical benefits of low serum digoxin concentrations in heart failure. J Am Coll Cardiol. 2002;39:946–953
  26. Ware JA, Snow E, Luchi JM, Luchi RJ. Effect of digoxin on ejection fraction in elderly patients with congestive heart failure. J Am Geriatr Soc. 1984;32:631–635
  27. Rathore SS, Curtis JP, Wang Y, Bristow MR, Krumholz HM. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA. 2003;289:871–878
  28. Misiaszek B, Heckman GA, Merali F, et al. Digoxin prescribing for heart failure in elderly residents of long-term care facilities. Can J Cardiol. 2005;21:281–286
  29. Aronow WS. Prevalence of appropriate and inappropriate indications for use of digoxin in older patients at the time of admission to a nursing home. J Am Geriatr Soc. 1996;44:588–590
  30. Ahmed A, Rich MW, Fleg JL, et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: The ancillary digitalis investigation group trial. Circulation. 2006;114:397–403Epub Jul 24, 2006
  31. Aronow WS. Epidemiology, pathophysiology, prognosis, and treatment of systolic and diastolic heart failure. Cardiol Rev. 2006;14:108–124
  32. Forman DE, Coletta D, Kenny D, et al. Clinical issues related to discontinuing digoxin therapy in elderly nursing home patients. Arch Intern Med. 1991;151:2194–2198
  33. Wilkins CE, Khurana MS. Digitalis withdrawal in elderly nursing home patients. J Am Geriatr Soc. 1985;33:850–851
  34. Macarthur C. Withdrawal of maintenance digoxin from institutionalized elderly. Postgrad Med J. 1990;66:940–942
  35. Fonrose HA, Ahlbaum N, Bugatch E, Cohen M, Genovese C, Kelly J. The efficacy of digitalis withdrawal in an institutional aged population. J Am Geriatr Soc. 1974;22:208–211

PII: S1525-8610(06)00452-X

doi: 10.1016/j.jamda.2006.08.010

JAMDA
Volume 7, Issue 9 , Pages 581-586 , November 2006