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. 2023 Dec:10:100048.
doi: 10.1016/j.ajmo.2023.100048. Epub 2023 Jun 24.

Patterns of Digoxin Prescribing for Medicare Beneficiaries in the United States 2013-2019

Claudia See  1 , Kevin M Wheelock  2 , César Caraballo  3 , Rohan Khera  1   3 , Amarnath Annapureddy  1 , Shiwani Mahajan  2   3 , Yuan Lu  1   3 , Harlan M Krumholz  1   3   4 , Karthik Murugiah  1   3
Affiliations

Patterns of Digoxin Prescribing for Medicare Beneficiaries in the United States 2013-2019

Claudia See et al. Am J Med Open. 2023 Dec.

Abstract

Background: Studies show that digoxin use is declining but is still prevalent. Recent data on digoxin prescription and characteristics of digoxin prescribers are unknown, which can help understand its contemporary use.

Methods: Using Medicare Part D data from 2013 to 2019, we studied the change in number and proportion of digoxin prescriptions and digoxin prescribers, overall and by specialty. Using logistic regression, we identified prescriber characteristics associated with digoxin prescription.

Results: From 2013 to 2019, total digoxin prescriptions (4.6 to 1.8 million) and proportion of digoxin prescribers decreased (9.1% to 4.3% overall; 26.6% to 11.8% among General Medicine prescribers and 65.4% to 48.9% among Cardiology). Of digoxin prescribers from 2013 practicing in 2019 (91.2% remained active), 59.1% did not prescribe digoxin at all, 31.7% reduced, and 9.2% maintained or increased prescriptions. The proportion of all digoxin prescriptions that were prescribed by General Medicine prescribers declined from 59.7% to 48.2% and increased for Cardiology (29% to 38.5%). Among new prescribers in 2019 (N = 85,508), only 1.9% prescribed digoxin. Digoxin prescribers when compared to non-digoxin prescribers were more likely male, graduated from medical school earlier, were located in the Midwest or South, and belonged to Cardiology (all P < .001).

Conclusions: Digoxin prescriptions continue to decline with over half of 2013 prescribers no longer prescribing digoxin in 2019. This may be a result of the increasing availability of newer heart failure therapies. The decline in digoxin prescription was greater among general medicine physicians than cardiologists, suggesting a change in digoxin use to a medication prescribed increasingly by specialists.

Keywords: Digoxin; Practice variation; Prescription patterns.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rohan Khera reports a relationship with NEJM Journal Watch that includes: consulting or advisory. Rohan Khera reports a relationship with Evidence2Health that includes: employment. Rohan Khera has pending Provisional Patent Application No. 63/177,177. Harlan Krumholz reports a relationship with UnitedHealth, Element Science, Aetna, Reality Labs, Tesseract/4Catalyst, F-Prime, the Siegfried and Jensen Law Firm, Arnold and Porter Law Firm, and Martin/Baughman Law Firm that includes: consulting or advisory. Harlan Krumholz reports a relationship with Refactor Health and HugoHealth that includes: employment. Harlan Krumholz reports a relationship with the Centers for Medicare & Medicaid Services and Johnson & Johnson that includes: employment. Yuan Lu reports a relationship with National Heart Lung and Blood Institute that includes: funding grants. Karthik Murugiah reports a relationship with National Heart Lung and Blood Institute that includes: funding grants.

Figures

Image, graphical abstract
Graphical abstract
Figure 1
Figure 1
Proportion of Digoxin Prescribers from 2013 to 2019 Overall and by Specialty. Line graph showing proportion of digoxin prescription of overall prescribers and in three specialty subgroups over time.
Figure 2
Figure 2
Forest Plot of 2019 Prescriber Characteristics Associated with Digoxin Prescription. Forest plot showing prescriber characteristics associated with digoxin prescription in a logistic regression model with odds ratios and 95% CI. *All P < .001 except West P = .739.
See this image and copyright information in PMC

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