Digoxin use in atrial fibrillation; Insights from National Ambulatory Medical Care Survey

Authors

Muhammad Nadeem Anwar, Internal Medicine Department, Veteran Affairs Medical Center OKC. Electronic address: nedo872@hotmail.com.
Usman Ahmad Khan, Internal Medicine Department, Veteran Affairs Medical Center OKC.
Aemen Shams Khakwani, Internal Medicine department Suburban community hospital, Norristown, PA.
Izza Saeed, Advocate Aurora HealthFollow
Hamza Ishfaq, Advocate Aurora HealthFollow
Muhammad Osama Muslim, Shifa College of Medicine, Islamabad.
Muhammad Faraz Anwaar, Internal Medicine Department, University of Oklahoma.

Recommended Citation

Anwar MN, Khan UA, Khakwani AS, et al. Digoxin Use in Atrial Fibrillation; Insights From National Ambulatory Medical Care Survey. Curr Probl Cardiol. 2023;48(8):101209. doi:10.1016/j.cpcardiol.2022.101209

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

OBJECTIVE: To evaluate the characteristics and trends of digoxin use during outpatient visits with atrial fibrillation in the US from 2006 to 2015. METHODS: We conducted a retrospective analysis of adult (age ≥18) patient visits to office-based physicians from National Ambulatory Medical Care Survey (NAMCS) database between 2006-2015. The International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify patients with atrial fibrillation. Visits in which digoxin was listed as a medication were analyzed with descriptive statistics. Multivariable logistic regression analysis was used to identify the predictors of digoxin usage. RESULTS: Of a weighted sample of 108,113,894 patient visits, 17,617,853 (16.3%) visits included use of digoxin. Patients who used digoxin had a mean age of 75 ± 0.7 years and were predominantly Caucasian (92.56%). Among the patients who used digoxin, 24% had a diagnosis of heart failure. Multivariate analysis showed that the increased likelihood of digoxin utilization was associated with female sex (adjusted odds ratio [aOR] 1.34, 95% CI 1.05-1.71, p = .019), heart failure (aOR 1.51, 95% CI 1.05-1.17, p = .025), and usage of ³5 medications (aOR 5.32, 95% CI 3.67-7.71, p = <0.001). Among the visits with atrial fibrillation, the percentage of visits with digoxin usage decreased from 23% in 2006 to 9% in 2013 and then again increased to 14% in 2015(P-trend <0.001). CONCLUSION: This is the first study to examine the use of digoxin in atrial fibrillation patients in a large outpatient setting. During 2006-2015, the percentage of digoxin prescriptions in atrial fibrillation patients has declined. Predictors of digoxin use in atrial fibrillation patients are female sex, congestive heart failure, and higher number of concurrent medications.

Document Type

Article

PubMed ID

35460684