Reasons prompting digitalis therapy in the acute care hospital

Background. The choice of administering digitalis to older patients with co ngestive heart failure (CHF) cannot be made on the account of univocally de fined criteria because of uncertainty about efficacy and concern about safe ty of digitalis in this population. The purpose of this study was to verify whether the clinical characteristics on admission to the acute care hospit al determine the use of digitalis therapy in elderly patients. Methods. A total of 1239 patients (mean age 77.8 +/- 7.1 years, range 65-10 0 years, males 49.8%) consecutively admitted to 69 General Medicine and Ger iatrics wards over a 4-month period were grouped by combining two dichotomo us factors (Carlson's score >4: definite or possible diagnosis of CHF; Carl son's score <5: unlikely diagnosis of CHF; in-hospital adoption of digitali s therapy: yes or no) as follows: Group A: Carlson's score >4, digitalis (n = 413); Group B: Carlson's score >4, no digitalis (n = 260); Group C: Carl son's score <5, digitalis (n = 104); Group D: Carl son's score <5, no digit alis (n = 462). Variables significantly distinguishing groups were entered into a discriminant analysis aimed at assessing the group specificity of in dividual clinical profiles. Results. Use of digoxin at home, atrial fibrillation, older age, and comorb idity (mainly COPD and chronic renal failure) characterized most of the pat ients given digoxin with or without a definite diagnosis of CHF. Clinical p rofiles of groups A, B, and C largely overlapped. Conclusion. Age, historical use of digitalis, and comorbidity might lead to seemingly incongruous digitalis prescription. The choice of adopting digit alis therapy cannot be reliably predicted on the basis of clinical variable s only. Presently unexplored physician-related factors, such as cultural ba ckground, likely outweigh clinical variables in prompting digitalis prescri ption.