Original Report

Increased risk of digoxin toxicity following hospitalization†

  1. Kevin Haynes PharmD, MSCE1,2,3,*,
  2. Sean Hennessy PharmD, PhD1,2,3,
  3. A. Russell Localio PhD1,2,3,
  4. Abigail Cohen PhD1,3,
  5. Charles E. Leonard PharmD1,2,3,
  6. Stephen E. Kimmel MD, MSCE1,3,
  7. Harold I. Feldman MD, MSCE1,3,
  8. Brian L. Strom MD, MPH1,2,3,
  9. Joshua P. Metlay MD, PhD1,2,3,4

Article first published online: 28 NOV 2008

DOI: 10.1002/pds.1680

Issue

Pharmacoepidemiology and Drug Safety

Pharmacoepidemiology and Drug Safety

Volume 18, Issue 1, pages 28–35, January 2009

Additional Information

How to Cite

Haynes, K., Hennessy, S., Localio, A. R., Cohen, A., Leonard, C. E., Kimmel, S. E., Feldman, H. I., Strom, B. L. and Metlay, J. P. (2009), Increased risk of digoxin toxicity following hospitalization. Pharmacoepidemiology and Drug Safety, 18: 28–35. doi: 10.1002/pds.1680

Author Information

  1. 1

    Program for the Reduction in Medication Errors, Department of Biostatistics and Epidemiology and School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

  2. 2

    Center for Education and Research on Therapeutics, Department of Biostatistics and Epidemiology and School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

  3. 3

    Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology and School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

  4. 4

    Center for Health Equity Research and Promotion, Veterans Affairs Medical Center, Philadelphia, PA, USA

*University of Pennsylvania School of Medicine, 711 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.

  1. †

    No conflict of interest was declared.

Publication History

  1. Issue published online: 29 DEC 2008
  2. Article first published online: 28 NOV 2008
  3. Manuscript Accepted: 14 OCT 2008
  4. Manuscript Revised: 26 SEP 2008
  5. Manuscript Received: 11 APR 2008

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Keywords:

  • adverse effects;
  • drug toxicity;
  • physician–patient relationships

Abstract

Purpose

Adverse drug events (ADEs) are an important cause of preventable hospitalizations among elderly individuals taking high-risk medications. The objective of the study was to identify health care system factors that affect the risk of digoxin toxicity for older adults on digoxin.

Methods

We conducted a prospective cohort study of older adults within the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program, which provides comprehensive drug benefits for older adults with low income. Subjects were interviewed at the time of enrollment regarding the management and coordination of their health care as well as medication comprehension. Hospitalizations were identified by linking patient identifiers to a state-wide registry. Trained abstractors reviewed discharge summaries of possible digoxin related ADEs. Unadjusted and adjusted incidence rate ratios (IRR) were calculated based on person–months of exposure using Poisson regression models, with variances adjusted for within subject repeated measures.

Results

We enrolled a total of 2030 adults on digoxin from May 2002 to June 2003. A total of 34 hospitalizations due to digoxin toxicity occurred, equivalent to 1.12 hospitalizations per 1000 person–months of exposure. Adjusting for hospitalization in the past 2 months, age, total number physicians prescribing any medications in past 3 months, total number of pharmacies filling medications in past 3 months, and number of unique prescriptions filled in the past month had a 4.25-fold increased risk of subsequently experiencing digoxin toxicity (IRR 95%CI 1.95, 9.27).

Conclusions

The risk of digoxin toxicity-related hospitalization, while low, is higher in the post-hospital period. Copyright © 2008 John Wiley & Sons, Ltd.

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