SHOULD DIGOXIN BE PROSCRIBED IN ELDERLY SUBJECTS IN SINUS RHYTHM FREEFROM HEART-FAILURE - A POPULATION-BASED STUDY

Increased mortality in digoxin-treated subjects has been demonstrated in patients with recent myocardial infarction. Those with congestive h eart failure (CHF) due to causes other than myocardial infarction seem to be free from this effect. No information is currently available co ncerning mortality in elderly people who are frequently prescribed dig italis even in the absence of CHF. The aim of this study was to invest igate whether subjects improperly receiving digoxin were worse off tha n those not receiving this drug. This analysis is a part of CASTEL, a population-based prospective study that has enrolled a cohort of 2,254 subjects aged greater than or equal to 65 years. CHF was diagnosed in 187 subjects and atrial fibrillation (AF) in 90. The remaining 1,977 were free from CHF and in sinus rhythm, but 447 were treated with digi talis. Cumulative mortality and morbid events by digitalis treatment w ere calculated in all these categories. Among subjects free from CHF a nd AF (improper use), all-cause and cardiovascular mortality was signi ficantly higher among those taking digitalis than in those who did not . Non-fatal events including CHF were also more apparent in the former than in the latter. Cox analysis confirmed digitalis as a predictor o f mortality in these subjects. No effect of digitalis on survival was found in patients with CHF or AF (proper use). In elderly subjects wit hout atrial fibrillation or CHF, the use of digitalis worsens morbidit y and mortality.