Summary

Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes

Enrique Martín Mojarro1, Víctor Gil2, Pere Llorens3, Jesús Álvarez2, Silvia Flores Quesada1, Osvaldo J. Troiano Ungerer1, Aitor Alquézar-Arbé4, Javier Jacob5, Pablo Herrero-Puente6, Begoña Espinosa3, Carolina Sánchez2, Lluis Llauger7, Josep Tost8, Leticia Serrano9, Aitor Dávila10, Raquel Torres Garate11, María Luisa López-Grima12, Francisco Javier Lucas-Imbernón13, Héctor Alonso14, Fran Pagán2, José Manuel Garrido15, Òscar Miró2 (en representación del grupo de investigación ICA-SEMES)

Affiliation of the authors

1Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain. 2Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, Spain. 3Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain. 4Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 5Servicio de Urgencias, Hospital Universitari de Bellvitge, l’Hospitalet de Llobregat, Barcelona, Spain. 6Servicio de Urgencias, Hospital Universitario Central de Asturias, Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA), Oviedo, Spain. 7Servicio de Urgencias, Althaia Xarxa Assistencial Universitària de Manresa, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Universitat de Vic-Central de Catalunya (UVIC-UCC), Barcelona, Spain. 8Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain. 9Servicio de Urgencias, Hospital Politécnico la Fe, Valencia, Spain. 10Servicio de Urgencias, Hospital Universitario de Salamanca, Spain. 11Servicio de Urgencias, Hospital Severo Ochoa, Madrid, Spain. 12Servicio de Urgencias, Hospital Dr Peset, Valencia, Spain. 13Servicio de Urgencias, Hospital General Universitario de Albacete, Spain. 14Servicio de Urgencias, Hospital Marqués de Valdecilla, Santander, Spain. 15Servicio de Urgencias, Hospital Virgen de la Macarena, Sevilla, Spain.

DOI

Icono PDF Download Article

Quote

Martín Mojarro E, Gil V, Llorens P, Álvarez J, Flores Quesada S, Troiano Ungerer OJ, et al. Use of digoxin in the emergency department to treat patients with acute heart failure and its impacton short-term outcomes. Emergencias. 2023;35:437-46

Summary

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.

 

More articles by the authors

Privacy Overview

This website uses cookies so that we can provide you with the best user experience possible. Cookie information is stored in your browser and performs functions such as recognising you when you return to our website and helping our team to understand which sections of the website you find most interesting and useful.