Effectiveness and costs of digoxin treatment for atrial fibrillation and flutter.
Clinical outcomes and costs associated with the use of digoxin in atrial fibrillation and flutter were evaluated in a prospective, observational study at 18 academic medical centers in the United States. Data were collected on 115 patients (aged > 18 years) with atrial fibrillation or flutter who were treated with digoxin for rapid ventricular rate (> or = 120 beats/min). The median time to ventricular rate control (i.e., resting ventricular rate < 100 beats/min, decrease in ventricular rate of > 20%, or sinus rhythm) was 11.6 hours from the first dose of digoxin for all evaluable patients (n = 105) and 9.5 hours for those only receiving digoxin (n = 64). Before ventricular rate control, the mean +/- SD dose of digoxin administered was 0.80 +/- 0.74 mg, and a mean of 1.4 +/- 1.8 serum digoxin concentrations were ordered per patient. Concomitant beta-blocker or calcium antagonist therapy was instituted in 47 patients (41%); in 19 of these, combination therapy was initiated within 2 hours. Adenosine was administered to 13 patients (11%). Patients spent a median of 4 days (range 1 to 25) in the hospital; 28% spent time in a coronary/intensive care unit and 79% in a telemetry bed. Loss of control (i.e., resting ventricular rate returned to > 120 beats/min) occurred at least once in 50% of patients and was associated with a longer hospital stay (p < 0.05). Based on 1991 data, the estimated mean hospital bed cost for patients with atrial fibrillation or flutter was $3,169 +/- $3,174.(ABSTRACT TRUNCATED AT 250 WORDS)
Roberts
S A
SA
Chicago College of Pharmacy, University of Illinois.
Diaz
C
C
Nolan
P E
PE
Salerno
D M
DM
Stapczynski
J S
JS
Zbrozek
A S
AS
Ritz
E G
EG
Bauman
J L
JL
Vlasses
P H
PH
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D001282:Atrial Flutter / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D004077:Digoxin / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000889:Anti-Arrhythmia Agents; D004077:Digoxin