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

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 unde...

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Autores: 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
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p17353
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17353
Access Level:acceso abierto
Palabra clave:Acute heart failure
Digoxin
Mortality
Emergency department
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spelling Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomesMojarro, EMGil, VLlorens, PAlvarez, JQuesada, SFUngerer, OJTAlquezar-Arbé, AJacob, JHerrero-Puente, PEspinosa, BSánchez, CLlauger, LTost, JSerrano, LDávila, AGarate, RTLópez-Grima, MLLucas-Imbernón, FJAlonso, HPagán, FGarrido, JMMiró, OAcute heart failureDigoxinMortalityEmergency departmentObjectives. 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.SANIDAD EDICIONES2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17353EMERGENCIASISSN: 11376821ISSNe: 23865857reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Españolinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p173532026-06-14T12:41:47Z
dc.title.none.fl_str_mv Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes
title Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes
spellingShingle Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes
Mojarro, EM
Acute heart failure
Digoxin
Mortality
Emergency department
title_short Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes
title_full Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes
title_fullStr Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes
title_full_unstemmed Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes
title_sort Use of digoxin in the emergency department to treat patients with acute heart failure and its impact on short-term outcomes
dc.creator.none.fl_str_mv 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
author Mojarro, EM
author_facet 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
author_role author
author2 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Acute heart failure
Digoxin
Mortality
Emergency department
topic Acute heart failure
Digoxin
Mortality
Emergency department
description 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.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17353
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17353
dc.language.none.fl_str_mv Español
language_invalid_str_mv Español
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SANIDAD EDICIONES
publisher.none.fl_str_mv SANIDAD EDICIONES
dc.source.none.fl_str_mv EMERGENCIAS
ISSN: 11376821
ISSNe: 23865857
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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repository.mail.fl_str_mv
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