title: Inappropriate use of digoxin in elderly patients presenting to an outpatient cardiology clinic of a tertiary hospital in Turkey.
abstract: OBJECTIVE
  We investigated the prevalence and indications of digoxin use in elderly patients presenting to a cardiology outpatient clinic of a tertiary hospital in Turkey.
  
  
  METHODS
  On a prospective basis, the study included 800 consecutive patients aged 70 or over (mean age 77 ± 6 years) who presented to our cardiology outpatient clinic. There were 124 patients (15.5%) receiving digoxin. All the patients underwent transthoracic echocardiography. Digoxin use was considered inappropriate if the patient had normal left ventricle systolic function or if there was no atrial fibrillation (AF).
  
  
  RESULTS
  The reasons for use of long-term digoxin were persistent AF (n=55, 44.4%), heart failure (HF) (n=51, 41.1%), and paroxysmal AF (n=8, 6.5%). The exact reason could not be determined in 10 patients (8.1%). Digoxin use was based on appropriate indications in 76 patients (61.3%), whereas 48 patients (38.7%) were taking digoxin with inappropriate indications. Of 51 patients for whom HF was the only reason for digoxin therapy, diagnosis of HF was incorrect in 30 patients (24.2%). Other inappropriate indications were paroxysmal AF and undetermined indication for digoxin prescription. Concerning digoxin dose, 24 patients (19.4%) received one tablet (0.25 mg) and 30 patients (24.2%) received a half tablet (0.125 mg) on a daily basis, while 10 patients (8.1%) used six tablets per week with one day off (0.214 mg/day) and 60 patients (48.4%) took five tablets per week with two days off (0.179 mg/day). The median daily dose was 0.182 mg/day. Digoxin dose was higher than the recommended doses for elderly patients in 75.8% of the patients.
  
  
  CONCLUSIONS
  Our findings show that nearly 40% of elderly patients receive digoxin with inappropriate indications and 75% of these patients take digoxin at higher doses than the recommended doses for this age group.
authors: Department of Cardiology, Haydarpaşa Numune Education and Research Hospital, İstanbul, Turkey. murbit2@yahoo.com
authors: Murat
authors: M
authors: Biteker
authors: Dursun
authors: D
authors: Duman
authors: Akın
authors: A
authors: Dayan
authors: Mehmet Mustafa
authors: MM
authors: Can
authors: Ahmet Ilker
authors: AI
authors: Tekkeşin
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004077:Digoxin / Q000008:administration & dosage*; D017548:Echocardiography, Transesophageal; D005260:Female; D006300:Health Services Misuse; D006299:Health Services for the Aged; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital; D015995:Prevalence; D011446:Prospective Studies; D014421:Turkey
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin