Effectiveness and costs of digoxin treatment for atrial fibrillation and flutter

Abstract

Clinical outcomes and costs associated with the use of digoxin in atrial fibrillation and flutter were evaluated in a prospective, observational study at 18 academic medical centers in the United States. Data were collected on 115 patients (aged >18 years) with atrial fibrillation or flutter who were treated with digoxin for rapid ventricular rate (≥120 beats/min). The median time to ventricular rate control (i.e., resting ventricular rate <100 beats/min, decrease in ventricular rate of >20%, or sinus rhythm) was 11.6 hours from the first dose of digoxin for all evaluable patients (n = 105) and 9.5 hours for those only receiving digoxin (n = 64). Before ventricular rate control, the mean ± SD dose of digoxin administered was 0.80 ± 0.74 mg, and a mean of 1.4 ± 1.8 serum digoxin concentrations were ordered per patient. Concomitant β-blocker or calcium antagonist therapy was instituted in 47 patients (41%); in 19 of these, combination therapy was initiated within 2 hours. Adenosine was administered to 13 patients (11%). Patients spent a median of 4 days (range 1 to 25) in the hospital; 28% spent time in a coronary/intensive care unit and 79% in a telemetry bed. Loss of control (i.e., resting ventricular rate returned to ≥120 beats/min) occurred at least once in 50% of patients and was associated with a longer hospital stay (p < 0.05). Based on 1991 data, the estimated mean hospital bed cost for patients with atrial fibrillation or flutter was $3,169 ± $3,174. The current therapeutic approach to patients with atrial fibrillation or flutter and a rapid ventricular rate is inconsistent, inefficient and in some cases inappropriate. The development of treatment guidelines for atrial fibrillation or flutter could represent a useful strategy for reducing costs of arrhythmia-related hospitalizations.