title: Emergency department visits and hospitalizations for digoxin toxicity: United States, 2005 to 2010.
abstract: BACKGROUND
  Recent data on digoxin prescribing and adverse events are lacking but could help inform the management of digoxin in contemporary heart failure treatment.
  
  
  RESULTS
  We determined nationally representative numbers and rates of emergency department (ED) visits for digoxin toxicity in the United States using 2005 to 2010 reports from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and the National Ambulatory (and Hospital Ambulatory) Medical Care Surveys. Based on 441 cases, an estimated 5156 (95% confidence interval [CI], 2663-7648) ED visits for digoxin toxicity occurred annually in the United States; more than three fourths (78.8% [95% CI, 73.5%-84.1%]) resulted in hospitalization. Serum digoxin level was ≥2.0 ng/mL for 95.8% (95% CI, 93.2%-98.4%) of estimated ED visits with levels reported (n=251 cases). The rate of ED visits per 10 000 outpatient prescription visits among patients≥85 years was twice that of patients 40 to 84 years (rate ratio, 2.4 [95% CI, 1.2-5.0]); among women, the rate was twice that of men (rate ratio, 2.3 [95% CI, 1.1-4.7]). Digoxin toxicity accounted for an estimated 1.0% (95% CI, 0.6%-1.4%) of ED visits for all adverse drug events among patients≥40 years, but an estimated 3.3% (95% CI, 2.3%-4.4%) of ED visits and 5.9% (95% CI, 4.0%-7.9%) of hospitalizations for all adverse drug events among patients≥85 years. Estimated annual ED visits and hospitalizations remained relatively constant from 2005 to 2010.
  
  
  CONCLUSIONS
  Digoxin toxicity is not declining; more careful prescribing to high-risk groups and improved monitoring of serum levels might be needed to reduce morbidity from outpatient digoxin use.
authors.affiliation: Division of Healthcare Quality Promotion, Epidemic Intelligence Service, Office of Science, Education, and Laboratory Services, and Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; and Cardiology Division, Emory University School of Medicine, Atlanta, GA.
authors.forename: Isaac
authors.initials: I
authors.lastname: See
authors.forename: Nadine
authors.initials: N
authors.lastname: Shehab
authors.forename: Scott R
authors.initials: SR
authors.lastname: Kegler
authors.forename: S Raja
authors.initials: SR
authors.lastname: Laskar
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Budnitz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data / Q000639:trends*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D004077:Digoxin / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000889:Anti-Arrhythmia Agents; D004077:Digoxin
keywords: digoxin; drug-related side effects and adverse reactions; emergency service, hospital; heart failure; hospitalization