Prevalence of appropriate and inappropriate indications for use of digoxin in older patients at the time of admission to a nursing home

OBJECTIVE: To investigate the prevalence of-digoxin use and appropriate and inappropriate indications for digoxin use in older patients at the time of admission to a nursing home. DESIGN: In a prospective study of 500 consecutive patients aged 60 years of age or older admitted to a nursing home, 96 (19%) patients were receiving digoxin at the time of admission to the nursing home. Appropriate and inappropriate indications for digoxin use were investigated in these 96 patients. SETTING: A large, long-term health care facility where 500 consecutive older patients were studied. PATIENTS: The 500 patients included 344 women and 156 men, mean age 81 +/- 8 years (range 60-100). MEASUREMENTS AND MAIN RESULTS: Ninety-six of the 500 patients (19%) were receiving digoxin at the time of admission to the nursing home. Fifty-one (53%) of the 96 patients receiving digoxin had an appropriate indication for digoxin use, and 45 (47%) had an inappropriate indication for digoxin use. Appropriate indications for digoxin use included atrial fibrillation with or without congestive heart failure (CHF) in 35 patients (36%) and CHF with sinus rhythm and abnormal left ventricular (LV) ejection fraction in 16 patients (17%). Inappropriate indications for digoxin use included CHF with sinus rhythm and normal LV ejection fraction in 18 patients (19%), misdiagnosis of edema or dyspnea as CHF in patients with sinus rhythm and normal LV ejection fraction in 17 patients (18%), history of possible (undocumented) paroxysmal atrial fibrillation in nine patients (9%), and sinus tachycardia in one patient (1%). Two of the 45 patients (5%) inappropriately treated with digoxin had evidence of digitalis toxicity on their admission electrocardiogram. CONCLUSIONS: The prevalence of digoxin use was 19% in older patients at the time of admission to the nursing home. Almost half of patients (47%) receiving digoxin at the time of admission had an inappropriate indication for digoxin use at that time.