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PREVALENCE OF INAPPROPRIATE USE OF DIGOXIN IN 136 PATIENTS ON DIGOXIN AND PREVALENCE OF USE OF WARFARIN OR ASPIRIN IN 89 PATIENTS WITH PERSISTENT OR PAROXYSMAL ATRIAL FIBRILLATION
October 2008, Vol 134, No. 4_MeetingAbstracts Abstract: Slide Presentations | October 2008
PREVALENCE OF INAPPROPRIATE USE OF DIGOXIN IN 136 PATIENTS ON DIGOXIN AND PREVALENCE OF USE OF WARFARIN OR ASPIRIN IN 89 PATIENTS WITH PERSISTENT OR PAROXYSMAL ATRIAL FIBRILLATION Paul Lleva, MD*; Wilbert S. Aronow, MD; Andrew H. Gutwein, MD New York Medical College, Valhalla, NY Chest. 2008;134(4_MeetingAbstracts):s1003. doi:10.1378/chest.134.4_MeetingAbstracts.s1003
Abstract PURPOSE:We investigated the prevalence of inappropriate use of digoxin in patients receiving it and of appropriate use of warfarin and aspirin in patients with paroxysmal or persistent atrial fibrillation (AF) after an educational program. METHODS:Following an educational program given by one of the authors (WSA), the medical records of 136 consecutive patients being treated with digoxin in the medical clinic (30 patients) or in the hospital (106 patients) at Westchester Medical Center/New York Medical College were reviewed to determine the prevalence of inappropriate use of digoxin. Of these 136 patients, 89 (65%) had persistent or paroxysmal AF. The prevalence of use of warfarin to maintain an INR between 2.0 and 3.0 or aspirin 325 mg daily was also investigated in the 89 patients with persistent or paroxysmal AF. The 136 patients included 80 men and 56 women, mean age 72 ± 10 years. RESULTS:Of 136 patients receiving digoxin 47 (35%) had heart failure with reduced left ventricular ejection fraction and symptoms despite optimal medical therapy, 82 (60%) had persistent atrial fibrillation (AF), and 7 (5%) had paroxysmal AF. The prevalence of inappropriate use of digoxin was 5% (the 7 patients with paroxysmal AF). Of 89 patients with persistent or paroxysmal AF, 70 (79%) were being treated with warfarin to maintain an International Normalized Ratio between 2.0 and 3.0, 15 (17%) were being treated with aspirin 325 mg daily, and 4 (4%) were not being treated with warfarin or aspirin. The prevalence of nonuse of warfarin or aspirin in patients with persistent or paroxysmal AF was 4%. CONCLUSION:After an educational program, the prevalence of inappropriate use of digoxin was 5%, and the prevalence of use of warfarin or aspirin for paroxysmal or persistent AF was 96%.
CLINICAL IMPLICATIONS:An educational program in an academic medical center is effective in causing a low prevalence of inappropriate use of digoxin (5%) and a high prevalence of use of warfarin or aspirin for treating paroxysmal or persistent AF (96%). DISCLOSURE:Paul Lleva, No Financial Disclosure Information; No Product/Research Disclosure Information Monday, October 27, 2008 10:30 AM - 12:00 PM
PREVALENCE OF INAPPROPRIATE USE OF DIGOXIN IN 136 PATIENTS ON DIGOXIN AND PREVALENCE OF USE OF WARFARIN OR ASPIRIN IN 89 PATIENTS WITH PERSISTENT OR PAROXYSMAL ATRIAL FIBRILLATION Paul Lleva, MD*; Wilbert S. Aronow, MD; Andrew H. Gutwein, MD New York Medical College, Valhalla, NY Chest. 2008;134(4_MeetingAbstracts):s1003. doi:10.1378/chest.134.4_MeetingAbstracts.s1003
Abstract PURPOSE:We investigated the prevalence of inappropriate use of digoxin in patients receiving it and of appropriate use of warfarin and aspirin in patients with paroxysmal or persistent atrial fibrillation (AF) after an educational program. METHODS:Following an educational program given by one of the authors (WSA), the medical records of 136 consecutive patients being treated with digoxin in the medical clinic (30 patients) or in the hospital (106 patients) at Westchester Medical Center/New York Medical College were reviewed to determine the prevalence of inappropriate use of digoxin. Of these 136 patients, 89 (65%) had persistent or paroxysmal AF. The prevalence of use of warfarin to maintain an INR between 2.0 and 3.0 or aspirin 325 mg daily was also investigated in the 89 patients with persistent or paroxysmal AF. The 136 patients included 80 men and 56 women, mean age 72 ± 10 years. RESULTS:Of 136 patients receiving digoxin 47 (35%) had heart failure with reduced left ventricular ejection fraction and symptoms despite optimal medical therapy, 82 (60%) had persistent atrial fibrillation (AF), and 7 (5%) had paroxysmal AF. The prevalence of inappropriate use of digoxin was 5% (the 7 patients with paroxysmal AF). Of 89 patients with persistent or paroxysmal AF, 70 (79%) were being treated with warfarin to maintain an International Normalized Ratio between 2.0 and 3.0, 15 (17%) were being treated with aspirin 325 mg daily, and 4 (4%) were not being treated with warfarin or aspirin. The prevalence of nonuse of warfarin or aspirin in patients with persistent or paroxysmal AF was 4%. CONCLUSION:After an educational program, the prevalence of inappropriate use of digoxin was 5%, and the prevalence of use of warfarin or aspirin for paroxysmal or persistent AF was 96%.
CLINICAL IMPLICATIONS:An educational program in an academic medical center is effective in causing a low prevalence of inappropriate use of digoxin (5%) and a high prevalence of use of warfarin or aspirin for treating paroxysmal or persistent AF (96%). DISCLOSURE:Paul Lleva, No Financial Disclosure Information; No Product/Research Disclosure Information Monday, October 27, 2008 10:30 AM - 12:00 PM