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Hospitalizations With Adverse Events Caused by Digitalis Therapy Among Elderly Medicare Beneficiaries

Hospitalizations With Adverse Events Caused by Digitalis Therapy Among Elderly Medicare... Abstract Background: Digitalis products are among the agents most frequently prescribed to the elderly, yet previous studies have not provided age-, race-, and sex-specific rates of utilization of digitalis by this population. Estimates of the rate of hospitalization with an adverse reaction from digitalis therapy have varied considerably between systems relying on passive reports and those using active surveillance. Methods: Medicare data from 1985 through 1991 and data from the 1987 National Medical Expenditure Survey were used to determine population-based estimates of the use of digitalis in elderly beneficiaries by age group, sex, and race. Hospitalization rates with an adverse event caused by digitalis therapy were calculated for those persons estimated to be using digitalis. Medicare data were used to identify the frequency of selected comorbidities among persons with an adverse event caused by digitalis therapy as well as the frequency of clinical manifestations associated with digitalis intoxication. Results: Over 3 million Medicare beneficiaries were estimated to be using digitalis in 1987. A total of 202011 hospitalizations with a coded adverse event caused by digitalis therapy were reported during the 7-year study period. Of persons estimated to be using digitalis, 8.53 per 1000 were hospitalized annually with an adverse event caused by digitalis therapy. Women, individuals with increasing age, and persons of black race, especially those with impaired renal function, were significantly (P<.05) more likely to experience hospitalization with an adverse event caused by digitalis therapy. Conclusion: This information may help identify categories of elderly patients who require more frequent monitoring to prevent adverse effects of digitalis therapy. Changes in the format of the hospital bill to include more diagnoses along with increased mandatory reporting of adverse drug events will improve the sensitivity of Medicare data for surveillance of adverse drug events.(Arch Intern Med. 1994;154:1482-1487) References 1. Physicians' Desk Reference . 45th ed. Oradell, NJ: Medical Economics Co; 1991. 2. Olin BR, ed. Drug Facts and Comparisons . St Louis, Mo: Facts and Comparisons Inc; 1992. 3. Carlson KJ, Lee DS, Goroll AH, Leahy M, Johnson RA. An analysis of physicians' reasons for prescribing long-term digitalis therapy in outpatients . J Chronic Dis . 1985;38:733-739.Crossref 4. Impivaara O, lisalo E, Aromaa A, Maatela J, Reunanen A. Overprescription and underprescription of digitalis . Acta Med Scand . 1986;219:455-460.Crossref 5. National Prescription Audit. Plymouth Meeting , Pa: IMS America; 1984-1991. 6. Moeller J, Mathiwetz N. Prescribed Medicines: A Summary of Use and Expenditures by Medicare Beneficiaries . Rockville, Md: National Center for Health Services Research and Health Care Technology Assessment, Public Health Service; 1989. US Dept of Health and Human Services publication PHS 89-3448. [National Medical Expenditure Survey Research Findings 3.] 7. Beller GA, Smith TW, Abelmann WH, Haber E, Hood WB. Digitalis intoxication: a prospective clinical study with serum level correlations . N Engl J Med . 1971; 284:989-996.Crossref 8. Boman K. Digitalis intoxication in geriatric patients . Acta Med Scand . 1983; 214:345-351.Crossref 9. Evered DC, Chapman C. Plasma digoxin concentrations and digoxin toxicity in hospital patients . Br Heart J . 1971;33:540-545.Crossref 10. Grymonpre RE, Mitenko PA, Sitar DS, Aoki FY, Montgomery PR. Drugassociated hospital admission in older medical patients . J Am Geriatr Soc . 1988; 36:1092-1098. 11. Shapiro S, Sloane D, Lewis GP, Jick H. The epidemiology of digoxin . J Chronic Dis . 1969;22:361-371.Crossref 12. Kahn HA, Sempos CT. Statistical Methods in Epidemiology . New York, NY: Oxford University Press Inc; 1989. 13. International Classification of Diseases, Ninth Revision, Clinical Modification . Washington, DC: Public Health Service, US Dept of Health and Human Services; 1988. 14. Smith TW, Antman EM, Friedman PL, Blatt CM. Digitalis glycosides: mechanisms and manifestations of toxicity . Prog Cardiovasc Dis . 1984;26:413-458.Crossref 15. Minson RB, McRitchie RJ. Digoxin in the 1980s . Med J Aust . 1987;147:403-410. 16. Rawlins MD. Clinical pharmacology: adverse reactions to drugs . BMJ . 1981; 282:974-976.Crossref 17. Levy M, Lipshitz M, Eliakim M. Hospital admissions due to adverse drug reactions . Am J Med Sci . 1979;227:49-56.Crossref 18. Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients . JAMA . 1991;266:2847-2851.Crossref 19. Edlavitch SA. Adverse drug event reporting: improving the low US reporting rates . Arch Intern Med . 1988;148:1499-1503.Crossref 20. Romano P, Luft HS. Getting the most out of messy data: problems and approaches for dealing with large administrative data sets . In: Grady ML, Schwartz HA, eds. Medical Effectiveness Research Data Methods . Rockville, Md: Agency for Health Care Policy and Research; 1992:57-75. Publication 92-0056. 21. Duhme DW, Greenblatt DJ, Koch-Weser J. Reduction of digoxin toxicity associated with measurement of serum levels . Ann Intern Med . 1974;80:516-519.Crossref 22. Carruthers SG, Kelly JG, McDevitt DG. Plasma digoxin concentrations in patients on admission to hospital . Br Heart J . 1974;36:707-712.Crossref 23. Moorman JR. Digitalis toxicity at Duke Hospital, 1973-1984 . South Med J . 1985; 78:561-564.Crossref 24. Mahdyoon H, Battilana G, Rosman H, Goldstein S, Gheorghiade M. The evolving pattern of digoxin intoxication: observations at a large urban hospital from 1980 to 1988 . Am Heart J . 1990;120:1189-1194.Crossref 25. Marganitt B, MacKenzie EJ, Smith GS, Damianoa AM. Coding external causes of injury (E-codes) in Maryland hospital discharges 1979-1988: a statewide study to explore the uncoded population . Am J Public Health . 1990;10:1464-1466. 26. Jencks SF, Williams DK, Kay TL. Assessing hospital-associated deaths from discharge data: the role of length of stay and comorbidities . JAMA . 1988;260: 2240-2246.Crossref 27. Landahl S, Lindblad B, Roupe S, Steen B, Svanborg A. Digitalis therapy in a 70 year old population . Acta Med Scand . 1977;202:437-443.Crossref 28. Webb BW. The outpatient use of digitalis: a chart audit . J Fam Pract . 1978;6: 39-45. 29. Boman K, Allgulander S, Skoglind M. Is maintenance digoxin necessary in geriatric patients? Acta Med Scand . 1981;210:493-495.Crossref 30. Dobbs SM, Kenyons WI, Dobbs RJ. Maintenance digoxin after an episode of heart failure: placebo-controlled trial in outpatients . BMJ . 1977;1:749-752.Crossref 31. Gheorghiade M, Beller GA. Effects of discontinuing maintenance digoxin therapy in patients with ischemic heart disease and congestive heart failure in sinus rhythm . Am J Cardiol . 1983;51:1243-1250.Crossref 32. Kirsten E, Rodstein M, luster Z. Digoxin in the aged . Geriatrics . (January) 1973; 28:95-101. 33. Lee DCS, Johnson RA, Bingham JB, et al. Heart failure in outpatients . N Engl J Med . 1982;306:699-705.Crossref 34. Mulrow CD, Feussner JR, Velez R. Reevaluation of digitalis efficacy . Ann Intern Med . 1984;101:113-117.Crossref 35. Murray RG, Tweddel AC, Martin W, Pearson D, Hutton I, Lawrie TDV. Evaluation of digitalis in cardiac failure . BMJ . 1982;284:1526-1528.Crossref 36. Ordog GJ, Beraron S, Bhasin V, Wasserberger J, Balasubramanium S. Serum digoxin levels and mortality in 5,100 patients . Ann Emerg Med . 1987;16:32-38.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Hospitalizations With Adverse Events Caused by Digitalis Therapy Among Elderly Medicare Beneficiaries

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420130074010
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Digitalis products are among the agents most frequently prescribed to the elderly, yet previous studies have not provided age-, race-, and sex-specific rates of utilization of digitalis by this population. Estimates of the rate of hospitalization with an adverse reaction from digitalis therapy have varied considerably between systems relying on passive reports and those using active surveillance. Methods: Medicare data from 1985 through 1991 and data from the 1987 National Medical Expenditure Survey were used to determine population-based estimates of the use of digitalis in elderly beneficiaries by age group, sex, and race. Hospitalization rates with an adverse event caused by digitalis therapy were calculated for those persons estimated to be using digitalis. Medicare data were used to identify the frequency of selected comorbidities among persons with an adverse event caused by digitalis therapy as well as the frequency of clinical manifestations associated with digitalis intoxication. Results: Over 3 million Medicare beneficiaries were estimated to be using digitalis in 1987. A total of 202011 hospitalizations with a coded adverse event caused by digitalis therapy were reported during the 7-year study period. Of persons estimated to be using digitalis, 8.53 per 1000 were hospitalized annually with an adverse event caused by digitalis therapy. Women, individuals with increasing age, and persons of black race, especially those with impaired renal function, were significantly (P<.05) more likely to experience hospitalization with an adverse event caused by digitalis therapy. Conclusion: This information may help identify categories of elderly patients who require more frequent monitoring to prevent adverse effects of digitalis therapy. Changes in the format of the hospital bill to include more diagnoses along with increased mandatory reporting of adverse drug events will improve the sensitivity of Medicare data for surveillance of adverse drug events.(Arch Intern Med. 1994;154:1482-1487) References 1. Physicians' Desk Reference . 45th ed. Oradell, NJ: Medical Economics Co; 1991. 2. Olin BR, ed. Drug Facts and Comparisons . St Louis, Mo: Facts and Comparisons Inc; 1992. 3. Carlson KJ, Lee DS, Goroll AH, Leahy M, Johnson RA. An analysis of physicians' reasons for prescribing long-term digitalis therapy in outpatients . J Chronic Dis . 1985;38:733-739.Crossref 4. Impivaara O, lisalo E, Aromaa A, Maatela J, Reunanen A. Overprescription and underprescription of digitalis . Acta Med Scand . 1986;219:455-460.Crossref 5. National Prescription Audit. Plymouth Meeting , Pa: IMS America; 1984-1991. 6. Moeller J, Mathiwetz N. Prescribed Medicines: A Summary of Use and Expenditures by Medicare Beneficiaries . Rockville, Md: National Center for Health Services Research and Health Care Technology Assessment, Public Health Service; 1989. US Dept of Health and Human Services publication PHS 89-3448. [National Medical Expenditure Survey Research Findings 3.] 7. Beller GA, Smith TW, Abelmann WH, Haber E, Hood WB. Digitalis intoxication: a prospective clinical study with serum level correlations . N Engl J Med . 1971; 284:989-996.Crossref 8. Boman K. Digitalis intoxication in geriatric patients . Acta Med Scand . 1983; 214:345-351.Crossref 9. Evered DC, Chapman C. Plasma digoxin concentrations and digoxin toxicity in hospital patients . Br Heart J . 1971;33:540-545.Crossref 10. Grymonpre RE, Mitenko PA, Sitar DS, Aoki FY, Montgomery PR. Drugassociated hospital admission in older medical patients . J Am Geriatr Soc . 1988; 36:1092-1098. 11. Shapiro S, Sloane D, Lewis GP, Jick H. The epidemiology of digoxin . J Chronic Dis . 1969;22:361-371.Crossref 12. Kahn HA, Sempos CT. Statistical Methods in Epidemiology . New York, NY: Oxford University Press Inc; 1989. 13. International Classification of Diseases, Ninth Revision, Clinical Modification . Washington, DC: Public Health Service, US Dept of Health and Human Services; 1988. 14. Smith TW, Antman EM, Friedman PL, Blatt CM. Digitalis glycosides: mechanisms and manifestations of toxicity . Prog Cardiovasc Dis . 1984;26:413-458.Crossref 15. Minson RB, McRitchie RJ. Digoxin in the 1980s . Med J Aust . 1987;147:403-410. 16. Rawlins MD. Clinical pharmacology: adverse reactions to drugs . BMJ . 1981; 282:974-976.Crossref 17. Levy M, Lipshitz M, Eliakim M. Hospital admissions due to adverse drug reactions . Am J Med Sci . 1979;227:49-56.Crossref 18. Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients . JAMA . 1991;266:2847-2851.Crossref 19. Edlavitch SA. Adverse drug event reporting: improving the low US reporting rates . Arch Intern Med . 1988;148:1499-1503.Crossref 20. Romano P, Luft HS. Getting the most out of messy data: problems and approaches for dealing with large administrative data sets . In: Grady ML, Schwartz HA, eds. Medical Effectiveness Research Data Methods . Rockville, Md: Agency for Health Care Policy and Research; 1992:57-75. Publication 92-0056. 21. Duhme DW, Greenblatt DJ, Koch-Weser J. Reduction of digoxin toxicity associated with measurement of serum levels . Ann Intern Med . 1974;80:516-519.Crossref 22. Carruthers SG, Kelly JG, McDevitt DG. Plasma digoxin concentrations in patients on admission to hospital . Br Heart J . 1974;36:707-712.Crossref 23. Moorman JR. Digitalis toxicity at Duke Hospital, 1973-1984 . South Med J . 1985; 78:561-564.Crossref 24. Mahdyoon H, Battilana G, Rosman H, Goldstein S, Gheorghiade M. The evolving pattern of digoxin intoxication: observations at a large urban hospital from 1980 to 1988 . Am Heart J . 1990;120:1189-1194.Crossref 25. Marganitt B, MacKenzie EJ, Smith GS, Damianoa AM. Coding external causes of injury (E-codes) in Maryland hospital discharges 1979-1988: a statewide study to explore the uncoded population . Am J Public Health . 1990;10:1464-1466. 26. Jencks SF, Williams DK, Kay TL. Assessing hospital-associated deaths from discharge data: the role of length of stay and comorbidities . JAMA . 1988;260: 2240-2246.Crossref 27. Landahl S, Lindblad B, Roupe S, Steen B, Svanborg A. Digitalis therapy in a 70 year old population . Acta Med Scand . 1977;202:437-443.Crossref 28. Webb BW. The outpatient use of digitalis: a chart audit . J Fam Pract . 1978;6: 39-45. 29. Boman K, Allgulander S, Skoglind M. Is maintenance digoxin necessary in geriatric patients? Acta Med Scand . 1981;210:493-495.Crossref 30. Dobbs SM, Kenyons WI, Dobbs RJ. Maintenance digoxin after an episode of heart failure: placebo-controlled trial in outpatients . BMJ . 1977;1:749-752.Crossref 31. Gheorghiade M, Beller GA. Effects of discontinuing maintenance digoxin therapy in patients with ischemic heart disease and congestive heart failure in sinus rhythm . Am J Cardiol . 1983;51:1243-1250.Crossref 32. Kirsten E, Rodstein M, luster Z. Digoxin in the aged . Geriatrics . (January) 1973; 28:95-101. 33. Lee DCS, Johnson RA, Bingham JB, et al. Heart failure in outpatients . N Engl J Med . 1982;306:699-705.Crossref 34. Mulrow CD, Feussner JR, Velez R. Reevaluation of digitalis efficacy . Ann Intern Med . 1984;101:113-117.Crossref 35. Murray RG, Tweddel AC, Martin W, Pearson D, Hutton I, Lawrie TDV. Evaluation of digitalis in cardiac failure . BMJ . 1982;284:1526-1528.Crossref 36. Ordog GJ, Beraron S, Bhasin V, Wasserberger J, Balasubramanium S. Serum digoxin levels and mortality in 5,100 patients . Ann Emerg Med . 1987;16:32-38.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 11, 1994

References