Age- and Gender-Specific Incidence of Hospitalisation for Digoxin Intoxication
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Background: The safety of digoxin (digitalis) therapy has greatly improved over the past three decades, but recent incidence rates for digoxin intoxication-related hospitalisation are not available. Recent literature suggests that women are at higher risk of digoxin toxicity.
Objective: To provide age- and gender-specific incidence rates for digoxin intoxication-related hospitalisation and mortality during digoxin intoxication-related hospitalisation in The Netherlands in the period 2001–4.
Study design and methods: We conducted a nationwide population-based cohort-study of all hospital admissions in the years 2001–4 using a national computerised hospital admission registry. All patients with acute admissions were included in the study (n = 2 987 580). From these admissions, we selected all hospitalisations that had digoxin intoxication coded as either a primary or secondary diagnosis. We obtained data on digoxin prescriptions from the Foundation for Pharmaceutical Statistics (Stichting Farmaceutische Kengetallen) pharmacy database, which extrapolates drug figures for The Netherlands from prescriptions dispensed by 90% of all community pharmacies. We computed age- and gender-specific incidence rates of digoxin intoxication.
Results: Digoxin intoxication was identified in 0.04% (n = 1286) of acute admissions. The incidence rate for digoxin intoxication-related admission was 48.5 ( 95% CI 45.9, 51.2) per 100 000 prescriptions, which corresponds to 1.94 admissions for intoxication per 1000 treatment-years. Women had a 1.4-fold higher risk of intoxication than men (95% CI 1.3, 1.6). The age- and gender-adjusted relative risk of mortality in patients with digoxin intoxication compared with those admitted for other reasons was 0.7 (95% CI 0.5, 0.8).
Conclusion: This study shows that digoxin intoxication in patients receiving current therapy is presently infrequent and that women are at higher risk of digoxin intoxication than men.
- The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group. N Engl J Med 1997 Feb 20; 336(8): 525–33 CrossRef
- Uretsky BF, Young JB, Shahidi FE, et al. Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: results of the PROVED trial. PROVED Investigative Group. J Am Coll Cardiol 1993 Oct; 22(4): 955–62 CrossRef
- 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 Jul 1; 329(1): 1–7 CrossRef
- Boman K. Digitalis intoxication in geriatric in-patients: a prospective clinical study of the value of serum digitalis concentration measurement. Acta Med Scand 1983; 214(5): 345–51 CrossRef
- Hurwitz N, Wade OL. Intensive hospital monitoring of adverse reactions to drugs. BMJ 1969 Mar 1; 1(643): 531–6 CrossRef
- Beller GA, Smith TW, Abelmann WH, et al. Digitalis intoxication. A prospective clinical study with serum level correlations. N Engl J Med 1971 May 6; 284(18): 989–97 CrossRef
- Lehmann HU, Witt E, Temmen L, et al. [Life-threatening digitalis intoxication with and without additional diuretic treatment (author’s transi)] Lebensbedrohliche Digitalisintoxikationen mit und ohne saluretische Zusatztherapie. Dtsch Med Wochenschr 1978 Oct 6; 103(40): 1566–71 CrossRef
- Mahdyoon H, Battilana G, Rosman H, et al. The evolving pattern of digoxin intoxication: observations at a large urban hospital from 1980 to 1988. Am Heart J 1990 Nov; 120(5): 1189–94 CrossRef
- Steiner JF, Robbins LJ, Hammermeister KE, et al. Incidence of digoxin toxicity in outpatients. West J Med 1994 Nov; 161(5): 474–8
- 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 Oct 31; 347(18): 1403–11 CrossRef
- Williamson KM, Thrasher KA, Fulton KB, et al. Digoxin toxicity: an evaluation in current clinical practice. Arch Intern Med 1998 Dec 7–21;158(22): 2444–9 CrossRef
- Domanski M, Fleg J, Bristow M, et al. The effect of gender on outcome in digitalis-treated heart failure patients. J Card Fail 2005 Mar; 11(2): 83–6 CrossRef
- Ichikawa-Haraguchi M, Sumizawa T, Yoshimura A, et al. Progesterone and its metabolites: the potent inhibitors of the transporting activity of P-glycoprotein in the adrenal gland. Biochim Biophys Acta 1993 Nov 28; 1158(3): 201–8 CrossRef
- Schuetz EG, Furuya KN, Schuetz JD. Interindividual variation in expression of P-glycoprotein in normal human liver and secondary hepatic neoplasms. J Pharmacol Exp Ther 1995; 275(2): 1011–8
- Baylis C. Changes in renal hemodynamics and structure in the aging kidney; sexual dimorphism and the nitric oxide system. Exp Gerontol 2005 Apr; 40(4): 271–8 CrossRef
- Age- and Gender-Specific Incidence of Hospitalisation for Digoxin Intoxication
Volume 30, Issue 5 , pp 431-436
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- 1. Department of Epidemiology & Biostatistics, Erasmus University Medical Center, 3000CA, Rotterdam, PO Box 2040, The Netherlands
- 2. Inspectorate of Health Care, The Hague, The Netherlands
- 3. Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands