The Efficacy of Digitalis Withdrawal in an Institutional Aged Population

TLDR

Digitalis was often initiated in these patients following transient cardiac stress from acute illness, from which they subsequently recovered. The study aimed to determine whether continued digitalis therapy was necessary. Baseline serum digoxin levels and creatinine clearance were measured, with repeat assessments at three and seven weeks after digitalis withdrawal. Among 31 long‑term digitalis users without heart disease, 48% remained stable for four months after withdrawal, while 52% required re‑initiation within 3–21 days, suggesting that periodic reassessment of digitalis necessity is warranted.

Abstract

ABSTRACT: In a survey of an institutional geriatric population of 403 patients it was found that among 88 patients who were being maintained with digitalis, 31 had been receiving it for at least a year although currently there was no evidence of heart disease. A study was conducted to ascertain whether or not it was necessary to continue digitalis. Pertinent clinical and laboratory baseline data included serum digoxin levels and creatinine clearance; the remainder of the determinations were repeated three weeks and seven weeks after omission of digitalis. Baseline serum digoxin levels ranged from a trace to 2.7 ng/ml. Of the 31 patients, 15 (48 per cent) were successfully maintained without digitalis for four months. Because of slight signs of cardiac decompensation, digitalis was started again in the other 16 patients within three to twenty‐one days. However, the fact that 48 per cent of the series could be maintained without digitalis indicates the need for periodic re‐evaluation under such circumstances. Perhaps the drug was started originally because of transient cardiac stress induced by an acute illness, from which the patient recovered. In such cases, withdrawal of digitalis therapy may prove beneficial.