Evaluation of the Clinical Use of Serum Digoxin Radioimmunoassays

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Abstract
Of 2586 consecutive patients admitted to a private general teaching hospital 370 (14%) received digoxin therapy. Serum digoxin assays were performed on 261 of these 370 subjects. In a representative sample of 97 patients, 61 attending physicians were responsible for their care. The mean and median age of the patients was 70 yr (range, 39-96 yr) and 1/4 of them had a significant degree of renal impairment. Of the patients, 61% were being treated for congestive heart failure (CHF), and the remainder for atrial fibrillation with or without CHF. Overall, 67% of the serum digoxin assays were judged to be appropriate, particularly those requested for evaluation of possible digitalis toxicity or the dosage in renal impairment, but only 43% of the assays used to assess maintenance therapy or the patient''s compliance were deemed appropriate. A significant difference was found in the percentage of appropriate assays rated useful by the physicians, as compared to the percentage of inappropriate assays. Inappropriate serum digoxin assays cost .apprx. $30,000 annually in this 680-bed hospital. Stricter criteria for admission assays would eliminate much of this excessive usage.

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