PMID- 38116968
OWN - NLM
STAT- MEDLINE
DCOM- 20231221
LR  - 20240102
IS  - 2386-5857 (Electronic)
IS  - 1137-6821 (Linking)
VI  - 35
IP  - 6
DP  - 2023 Dec
TI  - Use of digoxin in the emergency department to treat patients with acute heart 
      failure and its impact on short-term outcomes.
PG  - 437-446
AB  - 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. MATERIAL AND 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. CONCLUSION: 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.
FAU - Martin Mojarro, Enrique
AU  - Martin Mojarro E
AD  - Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Espana.
FAU - Gil, Victor
AU  - Gil V
AD  - Area de Urgencias, Hospital Clinic Barcelona, IDIBAPS, Universitat de Barcelona, 
      Espana.
FAU - Llorens, Pere
AU  - Llorens P
AD  - Servicio de Urgencias, Corta Estancia y Hospitalizacion a Domicilio, Hospital 
      General Dr. Balmis, Alicante, Instituto de Investigacion Sanitaria y Biomedica de 
      Alicante (ISABIAL), Universidad Miguel Hernandez, Alicante, Espana.
FAU - Alvarez, Jesus
AU  - Alvarez J
AD  - Area de Urgencias, Hospital Clinic Barcelona, IDIBAPS, Universitat de Barcelona, 
      Espana.
FAU - Flores Quesada, Silvia
AU  - Flores Quesada S
AD  - Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Espana.
FAU - Troiano Ungerer, Osvaldo J
AU  - Troiano Ungerer OJ
AD  - Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Espana.
FAU - Alquezar-Arbe, Aitor
AU  - Alquezar-Arbe A
AD  - Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Espana.
FAU - Jacob, Javier
AU  - Jacob J
AD  - Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de 
      Llobregat, Barcelona, Espana.
FAU - Herrero-Puente, Pablo
AU  - Herrero-Puente P
AD  - Servicio de Urgencias, Hospital Universitario Central de Asturias, Instituto de 
      Investigacion Biosanitaria del Principado de Asturias (ISPA), Oviedo, Espana.
FAU - Espinosa, Begona
AU  - Espinosa B
AD  - Servicio de Urgencias, Corta Estancia y Hospitalizacion a Domicilio, Hospital 
      General Dr. Balmis, Alicante, Instituto de Investigacion Sanitaria y Biomedica de 
      Alicante (ISABIAL), Universidad Miguel Hernandez, Alicante, Espana.
FAU - Sanchez, Carolina
AU  - Sanchez C
AD  - Area de Urgencias, Hospital Clinic Barcelona, IDIBAPS, Universitat de Barcelona, 
      Espana.
FAU - Llauger, Lluis
AU  - Llauger L
AD  - Servicio de Urgencias, Althaia Xarxa Assistencial Universitaria de Manresa, 
      Institut de Recerca i Innovacio en Ciencies de la Vida i de la Salut a la 
      Catalunya Central (IRIS-CC), Universitat de Vic-Central de Catalunya (UVIC-UCC), 
      Barcelona, Espana.
FAU - Tost, Josep
AU  - Tost J
AD  - Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Espana.
FAU - Serrano, Leticia
AU  - Serrano L
AD  - Servicio de Urgencias, Hospital Politecnico la Fe, Valencia, Espana.
FAU - Davila, Aitor
AU  - Davila A
AD  - Servicio de Urgencias, Hospital Universitario de Salamanca, Espana.
FAU - Torres Garate, Raquel
AU  - Torres Garate R
AD  - Servicio de Urgencias, Hospital Severo Ochoa, Madrid, Espana.
FAU - Lopez-Grima, Maria Luisa
AU  - Lopez-Grima ML
AD  - Servicio de Urgencias, Hospital Dr Peset, Valencia, Espana.
FAU - Lucas-Imbernon, Francisco Javier
AU  - Lucas-Imbernon FJ
AD  - Servicio de Urgencias, Hospital General Universitario de Albacete, Espana.
FAU - Alonso, Hector
AU  - Alonso H
AD  - Servicio de Urgencias, Hospital Marques de Valdecilla, Santander, Espana.
FAU - Pagan, Fran
AU  - Pagan F
AD  - Area de Urgencias, Hospital Clinic Barcelona, IDIBAPS, Universitat de Barcelona, 
      Espana.
FAU - Garrido, Jose Manuel
AU  - Garrido JM
AD  - Servicio de Urgencias, Hospital Virgen de la Macarena, Sevilla, Espana.
FAU - Miro, Oscar
AU  - Miro O
AD  - Area de Urgencias, Hospital Clinic Barcelona, IDIBAPS, Universitat de Barcelona, 
      Espana.
CN  - Grupo de investigacion ICA-SEMES
LA  - spa
LA  - eng
PT  - Journal Article
TT  - Uso de digoxina endovenosa en urgencias para tratar pacientes con insuficiencia 
      cardiaca aguda y su impacto en la evolucion a corto plazo.
PL  - Spain
TA  - Emergencias
JT  - Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias
JID - 9805751
RN  - 73K4184T59 (Digoxin)
SB  - IM
MH  - Humans
MH  - Female
MH  - Aged, 80 and over
MH  - Male
MH  - Digoxin/adverse effects
MH  - *Atrial Fibrillation
MH  - *Heart Failure/drug therapy/diagnosis
MH  - Emergency Service, Hospital
MH  - Hospitalization
OTO - NOTNLM
OT  - Acute heart failure.
OT  - Digoxin.
OT  - Digoxina.
OT  - Emergency department.
OT  - Insuficiencia cardiaca aguda.
OT  - Mortalidad.
OT  - Mortality.
OT  - Urgencias.
EDAT- 2023/12/20 12:42
MHDA- 2023/12/21 06:42
CRDT- 2023/12/20 08:24
PHST- 2023/12/21 06:42 [medline]
PHST- 2023/12/20 12:42 [pubmed]
PHST- 2023/12/20 08:24 [entrez]
PST - ppublish
SO  - Emergencias. 2023 Dec;35(6):437-446.