Author/Editor		Gričar, Marko; Latifić-Jasnič, Dunja; Kenda, Miran F
Title		Uporaba glikozidov digitalisa na kliničnem oddelku za kardiologijo - ali ravnamo pravilno?
Translated title		Use of cardiac glycosides at cardiology department - are we doing the right thing?
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 67, št. 12
Publication year		1998
Volume		str. 713-6
Language		slo
Abstract		Background. There still exists a controversy regarding the role, efficacy and safety of cardiac glycosides in management of patients with chronic heart failure specially when combined with normal sinus rhythm (1, 2). While expecting the results of Digitalis Investigation Group (DIG) study that showed the effect of digoxin on mortality and morbidity in patients with heart failure, we analysed the use of cardiac glycosides in a randomly chosen six-month period of our radiology department in order to assess the current practice of digoxin use including all pitfalls and possible mistakes. Methods and results. Medical files of 622 patients hospitalized at the department in a six-month period were analysed, especially the files of 63 patients (10.1%) that received cardiac glycosides. Digoxin has been prescribed to 44.5% of the latter even before admission. In 57.2% of patients receiving digoxin the rhythm was atril fibrillation (chronic or acute) while 42.8% had a normal sinus rhythm. As many as 75% of patients on digoxin were assigned to NYHA classes III or IV. In 88.9% of cases digoxin was used to treat chronic heart failure, however since 55.4% of patients with heart failure also had chronic atrial fibrillation, digoxin was in such cases used also to control heart rate. During hospitalizations serum levels of digoxin were determined at least once in 78%, more often in 28.4% and never in 22.2%. Serum digoxin concentrationon admission was determined in 57.1% of patients that have already receiving digoxin. Digoxin concentrations above therapeutic range were found in 12.7% of all patients receiving digoxin and (on admission) in 17.8% of patients that were on digoxin already prior to hospitalization. Two patients were admitted for suspected digitalis toxicity and only these two presented with mild symptoms of toxicity.(Abstract truncated at 2000 characters)
Summary		Izhodišča. Mnenja o vlogi, učinkovitosti in varnosti glikozidov digitalisa pri srčnem popuščanju in še zlasti ob prisotnosti sinusnega ritma so še vedno deljena (1, 2). V pričakovanju nedavno objavljenih rezultatov študije Digitalis Investigation Group (DIG), ki je pokazala vpliv digoksina na smrtnost in število hospitalizacij pri bolnikih s srčnim popuščanjem, smo analizirali uporabo glikozidov digitalisa na bolnišničnem kardiološkem oddelku v naključno izbranem šestmesečnem obdobju z namenom pridobiti kar najbolj verodostojen vzorčni posnetek dejanskega stanja na področju zdravljenja z digitalisom pri nas vključno z vsemi slabostmi in morebitnimi napakami. Metode in rezultati. Pregledali smo zdravstveno dokumentacijo 622 bolnikov, ki so se v šestih mesecih zdravili na oddelku za kardiologijo. Podrobno smo analizirali dokumetacijo 63 bolnikov (10,1%), ki so prejemali preparate digitalisa. Med temi jih je 44,5% glikozide digitalisa prejemalo že pred hospitalizacijo, ostalim so bili uvedeni v bolnišnici. V 57,2% sobili predpisani bolnikom z atrijsko fibrilacijo (kronično ali akutno) in v 42,8% bolnikom s sinusnim ritmom. Kar 75% bolnikov, ki so prejemali digitalis, je bilo uvrščenih v III. ali IV. funkcijski razred po klasifikaciji NYHA (New York Heart Association). V 88,9% so bili glikozidi digitalisa uporabljeni v okviru zdravljenja kroničnega srčnega popuščanja, pri čemer je imelo 55,4% bolnikov (ki so prejemali digitalis) s kroničnim popuščanjem tudi kronično atrijsko fibrilacijo, tako da je bil digitalis v teh primerih namenjen tudi kontroli frekvence perkatnega odgovora. Serumska koncentracija digoksina je bila vsaj enkrat določena pri 78% bolnikov, večkrat pri 28,4% bolnikov in nikoli pri 22,2% bolnikov. Ob sprejemu je bila določena pri 57,1% bolnikov, ki so digoksin prejemali že pred sprejemom v bolnišnico.(Izvleček pekinjen pri 2000 znakih)
Descriptors		HEART FAILURE, CONGESTIVE DIGITALIS GLYCOSIDES ATRIAL FIBRILLATION HOSPITALIZATION DIGOXIN DRUG THERAPY, COMBINATION