Contemporary Trends in the Use of and Expenditures on Digoxin in the United States

Alahmed, Abdullah A; Lauffenburger, Julie C.; Vaduganathan, Muthiah; Aldemerdash, Ahmed; Ting, Clara; Fatani, Nayyra; Fanikos, John; Buckley, Leo F.

doi:10.1007/s40256-022-00540-x

Cited by 4 publications

(8 citation statements)

References 18 publications

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“…Furthermore, it is a limitation that the MHS patients were all in the age range of 18–64 years. However, the racial/ethnic/gender demographics of our two groups were comparable, thus providing further support for our findings, regardless of the limitations [ 7 ]. It is also a limitation that it cannot be excluded that digoxin-dependent blockade of SARS-CoV-2 penetration into target cells [ 21 – 23 ] may have contributed to successful resistance to COVID-19 infection by HF patients receiving digoxin.…”

Section: Discussionsupporting

confidence: 78%

“…It is a limitation that there is a smaller number of digoxin-treated patients compared with those receiving standard of care. However, this is also generally the case for the comparison study of the US population at large [ 7 ]. Furthermore, it is a limitation that the MHS patients were all in the age range of 18–64 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, to the best of our knowledge, no trial is ongoing. An additional inference from this analysis, at least as it might inform regarding current digoxin treatment in the US population at large, is that the socioeconomic relegation of digoxin to the poor, to certain ethic groups, and to those with relevant comorbidities [7] does not necessarily carry with it a poor outcome for either HF treatment or resistance to COVID-19. However, an important caveat is that optimal care, as provided by the MHS to all patients, could be contributing to the equivalent outcome.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the United States (US), only digoxin is licensed, and it has been increasingly replaced by a standard-of-care group of drugs which include renin-angiotensin aldosterone inhibitors (ARNI), β-blockers, mineralocorticoid receptor antagonists (MRA), and the SGLT2 inhibitor. However, a recent analysis using the Medical Expenditure Panel Survey (MEPS) showed that an increasing proportion of digoxin users in the US population at large are adults living at or below the federal poverty level [ 7 ]. Consistently, the yearly median out-of-pocket cost for standard of care is US$2217.00, whereas that for digoxin is only US$60.00.…”

Section: Introductionmentioning

confidence: 99%

“…Consistently, the yearly median out-of-pocket cost for standard of care is US$2217.00, whereas that for digoxin is only US$60.00. Other digoxin users in this category are those who self-identify as either Asian or Hispanic [ 7 ], and those with comorbidities which are inconsistent with standard of care [ 8 , 9 ]. By contrast, the MEPS analysis also showed that digoxin use had declined among females and self-identified white adults [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Digoxin and Standard-of-Care Therapy for Heart Failure Patients with COVID-19: Analysis of Data from the US Military Health System (MHS) Data Repository

Banaag¹,

Pollard²,

Koehlmoos³

2023

Drugs - Real World Outcomes

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Background Cardiac glycosides such as digoxin, digitoxin and ouabain are still used around the world to treat patients with chronic heart failure with reduced ejection fraction (HFrEF) and/or atrial fibrillation (AF). However, in the US, only digoxin is licensed for treating these illnesses, and the use of digoxin for this group of patients is increasingly being replaced in the US by a new standard of care with groups of more expensive drugs. However, ouabain and digitoxin, and less potently digoxin, have also recently been reported to inhibit SARS-CoV-2 virus penetration into human lung cells, thus blocking COVID-19 infection. COVID-19 is known to be a more aggressive disease in patients with cardiac comorbidities, including heart failure. Objective We therefore considered the possibility that digoxin might provide at least a measure of relief from COVID-19 in digoxin-treated heart failure patients. To this end, we hypothesized that treatment with digoxin rather than standard of care might equivalently protect heart failure patients with regard to diagnosis of COVID-19, hospitalization and death. Methods To test this hypothesis, we conducted a cross-sectional study by using the US Military Health System (MHS) Data Repository to identify all MHS TRICARE Prime and Plus beneficiaries aged 18–64 years with a heart failure (HF) diagnosis during the period April 2020 to August 2021. In the MHS, all patients receive equal, optimal care without regard to rank or ethnicity. Analyses included descriptive statistics on patient demographics and clinical characteristics, and logistic regressions to determine likelihood of digoxin use. Results We identified 14,044 beneficiaries with heart failure in the MHS during the study period. Of these, 496 were treated with digoxin. However, we found that both digoxin-treated and standard-of-care groups were equivalently protected from COVID-19. We also noted that younger active duty service members and their dependents with HF were less likely to receive digoxin compared with older, retired beneficiaries with more comorbidities. Conclusion The hypothesis of equivalent protection by digoxin treatment of HF patients in terms of susceptibility to COVID-19 infection appears to be supported by the data. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-023-00360-8.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Digoxin and Standard-of-Care Therapy for Heart Failure Patients with COVID-19: Analysis of Data from the US Military Health System (MHS) Data Repository

Banaag¹,

Pollard²,

Koehlmoos³

2023

Drugs - Real World Outcomes

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Expert Consensus on the Diagnosis and Management of Digoxin Toxicity

Hack,

Wingate,

Zolty

et al. 2025

The American Journal of Medicine

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Efficacy of intravenous magnesium for the management of non‐post operative atrial fibrillation with rapid ventricular response: A systematic review and meta‐analysis

Enayati

Gin

Sajeev

et al. 2023

Cardiovasc electrophysiol

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Background: Intravenous magnesium (IV Mg), a commonly utilized therapeutic agent in the management of atrial fibrillation (AF) with rapid ventricular response, is thought to exert its influence via its effect on cellular automaticity and prolongation of atrial and atrioventricular nodal refractoriness thus reducing ventricular rate. We sought to undertake a systematic review and meta-analysis of the effectiveness of IV Mg versus placebo in addition to standard pharmacotherapy in the rate and rhythm control of AF in the nonpostoperative patient cohort given that randomized control trials (RCTs) have shown conflicting results.Methods: Randomized controlled trials comparing IV Mg versus placebo in addition to standard of care were identified via electronic database searches. Nine RCTs were returned with a total of 1048 patients. Primary efficacy endpoints were studydefined rate control and rhythm control/reversion to sinus rhythm. The secondary endpoint was patient experienced side effects.Results: Our analysis found IV Mg in addition to standard care was successful in achieving rate control (odd ratio [OR] 1.87, 95% confidence interval [CI] 1.13−3.11, p = .02) and rhythm control (OR 1.45, 95% CI 1.04−2.03, p = .03). Although not well reported among studies, there was no significant difference between groups regarding the likelihood of experiencing side effects.Conclusions: IV Mg, in addition to standard-of-care pharmacotherapy, increases the rates of successful rate and rhythm control in nonpostoperative patients with AF with rapid ventricular response and is well tolerated.

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Contemporary Trends in the Use of and Expenditures on Digoxin in the United States

Cited by 4 publications

References 18 publications

Digoxin and Standard-of-Care Therapy for Heart Failure Patients with COVID-19: Analysis of Data from the US Military Health System (MHS) Data Repository

Digoxin and Standard-of-Care Therapy for Heart Failure Patients with COVID-19: Analysis of Data from the US Military Health System (MHS) Data Repository

Expert Consensus on the Diagnosis and Management of Digoxin Toxicity

Efficacy of intravenous magnesium for the management of non‐post operative atrial fibrillation with rapid ventricular response: A systematic review and meta‐analysis

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