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Clinical Issues Related to Discontinuing Digoxin Therapy in Elderly Nursing Home Patients

Daniel E. Forman, MD; Deborah Coletta, RDCS; Donna Kenny, RDCS; Bernard D. Kosowsky, MD; John Stoukides, MD; Mark Rohrer, MD; John O. Pastore, MD
Arch Intern Med. 1991;151(11):2194-2198. doi:10.1001/archinte.1991.00400110056011.
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Digoxin is commonly used to treat congestive heart failure. Digoxin augments ventricular systolic performance, but does not benefit patients whose congestive heart failure is caused by poor diastolic function. We studied 47 elderly nursing home patients who were receiving long-term digoxin therapy. The left ventricular ejection fractions were measured using both a standard and a highly portable echocardiography machine. Thirty-five of 47 patients had normal ejection fractions (50% or greater). In this subgroup, 23 patients were in normal sinus rhythm. Digoxin was discontinued in 14 patients with good systolic function and normal sinus rhythm, but in nine cases physicians refused to stop the digoxin. Follow-up evaluations showed no deterioration off digoxin. Excellent correlations existed between estimated left ventricular ejection fractions from the two echocardiography machines. Many nursing home patients taking digoxin do not need it. Physician reluctance to discontinue digoxin may change with the availability of highly portable echocardiography.

(Arch Intern Med. 1991;151:2194-2198)


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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