Incidence of hospitalization for digitalis toxicity among elderly Americans.
OBJECTIVE
To document the prevalence of digitalis use and the incidence of hospitalization caused by digitalis toxicity.


METHODS
Observational cohort followed for 6 years.


METHODS
Urban community.


METHODS
Persons were eligible if they were (1) enrolled in the Yale Health and Aging Project and (2) using digitalis when interviewed in 1982 or 1985. The Project comprises a sample of noninstitutionalized persons aged 65 years and over living in New Haven, Connecticut.


METHODS
Between 1982 and 1988 when a Project participant was hospitalized in New Haven, a researcher reviewed the medical record and coded up to 16 International Classification of Diseases-Class 9 (ICD-9) diagnoses. To identify hospitalizations caused by digitalis, we reexamined records with ICD-9 codes suggesting toxicity. We confirmed the admission illness was an adverse drug reaction with a decision algorithm.


RESULTS
The prevalence of digitalis use was 13% in 1982 and 12% in 1985. The incidence of hospitalization caused by definite or probable toxicity was 4.2% (95% confidence interval = 0.3% to 8.1%) over 6 years. Manifestations of toxicity were malaise or gastrointestinal symptoms (two patients) and heart block plus malaise or gastrointestinal symptoms (six patients). Use of quinidine was associated (P < .05) with toxicity.


CONCLUSIONS
Knowledge about the incidence of severe, morbid toxicity may help clinicians estimate and compare the risks and benefits of digitalis and alternate therapies.
Kernan
W N
WN
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Castellsague
J
J
Perlman
G D
GD
Ostfeld
A
A
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003237:Connecticut / Q000453:epidemiology; D004071:Digitalis Glycosides / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D004358:Drug Therapy / Q000706:statistics & numerical data; D005260:Female; D006327:Heart Block / Q000139:chemically induced; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D009325:Nausea / Q000139:chemically induced; D010343:Patient Admission / Q000706:statistics & numerical data; D015995:Prevalence; D011802:Quinidine / Q000009:adverse effects; D012307:Risk Factors; D014839:Vomiting / Q000139:chemically induced
D004071:Digitalis Glycosides; D011802:Quinidine