EFFECTIVENESS AND COSTS OF DIGOXIN TREATMENT FOR ATRIAL-FIBRILLATION AND FLUTTER

Clinical outcomes and costs associated with the use of digoxin in atri al fibrillation and flutter were evaluated in a prospective, observati onal study at 18 academic medical centers in the United States. Data w ere collected on 115 patients (aged > 18 years) with atrial fibrillati on or flutter who were treated with digoxin for rapid ventricular rate (greater-than-or-equal-to 120 beats/min). The median time to ventricu lar rate control (i.e., resting ventricular rate < 100 beats/min, decr ease in ventricular rate of > 20%, or sinus rhythm) was 11.6 hours fro m 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 beta-blocker or calcium antagonist th erapy was instituted in 47 patients (41%); in 19 of these, combination therapy was initiated within 2 hours. Adenosine was administered to 1 3 patients (11%). Patients spent a median of 4 days (range 1 to 25) in the hospital; 28% spent time in a coronary/intensive cam unit and 79% in a telemetry bed. Loss of control (i.e., resting ventricular rate r eturned to greater-than-or-equal-to 120 beats/min) occurred at least o nce 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 f or 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 guidelin es for atrial fibrillation or flutter could represent a useful strateg y for reducing costs of arrhythmia-related hospitalizations.