Reassessment of indications for digoxin. Are patients being withdrawn?

Several studies have shown that the majority of patients receiving digoxin can be successfully withdrawn. A medical record review was conducted to determine whether, in practice, patients were being withdrawn from digoxin. Original indications for digoxin therapy in 163 outpatients were as follows: congestive heart failure (CHF), 50%; supraventricular tachycardia (SVT), 23%; CHF and SVT, 10%; and unknown/unclear, 17%. One third of these patients were withdrawn during the 3.5-year study, and 79% remained stable, off digoxin. The most significant predictor of withdrawal was chart indication of reassessment of the need for digoxin. The majority of the patients (68%) were reassessed, and of these, almost half were withdrawn. Physicians appear to be reassessing the need for digoxin therapy, resulting in higher withdrawal rates than previously reported. Results suggest that patients with unclear original indications, a onetime indication, or without clinical evidence of CHF or SVT can be successfully withdrawn.