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James L. Wofford, MD; Anne R. Hickey, MS; Walter H. Ettinger, MD; Curt D. Furberg, MD

Arch Intern Med. 1992;152(11):2261-2264.

Abstract
Background.—
Digoxin toxicity occurs most commonly among the elderly. While the clinical syndrome of digoxin toxicity is well understood, how toxic manifestations change with age is not known.

Methods.—
We performed secondary analysis of data from a postmarketing surveillance study of patients with life-threatening digoxin toxicity treated with digoxin antibody therapy. Patients receiving long-term maintenance digoxin therapy and aged 55 years or older were divided into four age groups: 55 to 64, 65 to 74, 75 to 84, and 85 years and older (n=45,167,183, and 83, respectively) and compared with regard to presenting manifestations, digoxin dosing, serum potassium and digoxin levels, and renal function.

Results.—
The prevalence of high-degree atrioventricular block showed an increasing but nonsignificant trend with age (40%, 40%, 42%, and 47%, respectively). Age-related trends in high-degree atrioventricular block were stronger among men than women and even stronger among men with underlying cardiac ischemia. The proportion of subjects with nausea/vomiting as a toxic manifestation did not consistently change with age (42%, 48%, 48%, and 46%, respectively). There were no age-related differences in degree of renal impairment or maintanence dose, but maintenance dose decreased with increasing renal impairment.

Conclusions.—
Among patients with life-threatening digoxin toxicity, there is no age-related difference in cliniccal presentation.

(Arch Intern Med. 1992;152:2261-2264)

Author Affiliations
From the Departments of Internal Medicine (Drs Wofford and Ettinger) and Public Health Sciences (Dr Furberg), Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC; and Epidemiology Section, Burroughs Wellcome Co, Research Triangle Park, NC (Ms Hickey).

Footnotes
Accepted for publication April 21, 1992.

Presented before the American Geriatrics Society, Atlanta, Ga, May 17, 1990.

Reprint requests to Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, NC 27103 (Dr Wofford).

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