Abstract
Background and Objective: The cardiac safety of digoxin therapy for congestive heart failure (CHF) is a source
of concern, especially among those with renal impairment.
Methods: Using a case–control design, we examined the risk of primary cardiac arrest (PCA)
associated with digoxin therapy within three levels of renal function.
Results: After adjustment for other clinical characteristics, digoxin therapy for CHF was
not associated with an increased risk of PCA [odds ratio (OR) = 0.97, 95% confidence interval (CI) 0.59–1.62] among patients with normal renal function
(serum creatinine ⩽1.1 mg/dL). In contrast, digoxin therapy was associated with a
modest increase in risk (OR = 1.58, CI 0.89–2.80) among patients with mild renal impairment (serum creatinine = 1.2–1.4 mg/dL); and a twofold increase in risk (OR = 2.39, CI 1.37–4.18) among patients with moderate renal impairment (serum creatinine = 1.5–3.5 mg/dL).
Conclusions: These findings suggest that the risks of digoxin may offset the benefits among patients
with moderately impaired renal function, but not among patients with normal renal
function.
Keywords
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References
- National patterns of angiotensinconverting enzyme inhibitor use in congestive heart failure.Arch Intern Med. 1997; 157: 2460-2464
- An explanation for varying views about digitalis efficacy in congestive heart failure.Cardiovasc Drugs Ther. 1989; 3: 19-20
- Digitalis.Circulation. 1999; 99: 1265-1270
- The effect of digoxin on mortality and morbidity in patients with heart failure.N Engl J Med. 1997; 336: 525-533
- Digitalis: mechanism of action and clinical use.N Engl J Med. 1988; 318: 358-365
- A nomogram for digoxin therapy.Am J Med. 1974; 57: 63-68
- Digitalis cardiotoxicity.J Am Coll Cardiol. 1985; 5: 91A-98A
- A case series of hospitalized patients with elevated digoxin levels.Am J Med. 1998; 105: 110-115
- Report of the Joint International Society and Federation Task Force of Cardiology. World Health Organization Task Force on Standardization of Clinical Nomenclature. Nomenclature and criteria for diagnosis of ischemic heart disease.Circulation. 1979; 59: 607-609
- Challenges in cardiac arrest research: data collection to assess outcomes.Ann Emerg Med. 1993; 22: 92-98
- Diseases of the kidney and urinary tract.in: The kidney: structure and function in health and disease. Oxford Univ Press, New York1951: 836-887
- Prediction of creatinine clearance from serum creatinine.Nephron. 1976; 16: 31-41
- A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation.Ann Intern Med. 1999; 130: 461-470
- Predictors of decreased renal function in patients with heart failure during angiotensin-converting enzyme inhibitor therapy: results from the studies of left ventricular dysfunction.Am Heart J. 1999; 138: 849-855
- Angiotensin-converting enzyme inhibitor use in older patients with heart failure and renal dysfunction.J Am Geriatr Soc. 1999; 47: 302-308
- Factors affecting tolerance to digitalis.J Am Coll Cardiol. 1985; 5: 69A-81A
- Angiotensin-converting enzyme inhibitor—associated elevations in serum creatinine: is this a cause for concern?.Arch Intern Med. 2000; 160: 685-693
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© 2003 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
