HOSPITALIZATIONS WITH ADVERSE EVENTS CAUSED BY DIGITALIS THERAPY AMONG ELDERLY MEDICARE BENEFICIARIES

Background: Digitalis products are among the agents most frequently pr escribed to the elderly, yet previous studies have not provided age-, race-, and sex-specific rates of utilization of digitalis by this popu lation. Estimates of the rate of hospitalization with an adverse react ion from digitalis therapy have varied considerably between systems re lying on passive reports and those using active surveillance. Methods: Medicare data from 1985 through 1991 and data from the 1987 National Medical Expenditure Survey were used to determine population-based est imates of the use of digitalis in elderly beneficiaries by age group, sex, and race. Hospitalization rates with an adverse event caused by d igitalis therapy were calculated for those persons estimated to be usi ng digitalis. Medicare data were used to identify the frequency of sel ected comorbidities among persons with an adverse event caused by digi talis therapy as well as the frequency of clinical manifestations asso ciated with digitalis intoxication. Results: Over 3 million Medicare b eneficiaries were estimated to be using digitalis in 1987. A total of 202 011 hospitalizations with a coded adverse event caused by digitali s therapy were reported during the 7-year study period. Of persons est imated to be using digitalis, 8.53 per 1000 were hospitalized annually with an adverse event caused by digitalis therapy. Women, individuals with increasing age, and persons of black race, especially those with impaired renal function, were significantly (P<.05) more likely to ex perience hospitalization with an adverse event caused by digitalis the rapy. Conclusion: This information may help identify categories of eld erly patients who require more frequent monitoring to prevent adverse effects of digitalis therapy. Changes in the format of the hospital bi ll to include more diagnoses along with increased mandatory reporting of adverse drug events will improve the sensitivity of Medicare data f or surveillance of adverse drug events.