Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Rea, T. D , D.S. Siscovick, B.M. Psaty, R.M. Pearce, Trivellore Raghunathan, E.A. Whitsel, L.A. Cobb, S. Weinmann, G.D. Anderson, P. Arbogast, and D.Y. Lin. 2003. "Digoxin Therapy and the Risk of Primary Cardiac Arrest in Patients With Congestive Heart Failure - Effect of Mild-Moderate Renal Impairment." Journal of Clinical Epidemiology, 56:646-650.
Background and Objective: The cardiac safety of digoxin therapy for congestive heart failure (CHF) is a source of concern, especially among those with renal impairment. Methods: Using a case-control design, we examined the risk of primary cardiac arrest (PCA) associated with digoxin therapy within three levels of renal function. Results: After adjustment for other clinical characteristics, digoxin therapy for CHF was not associated with an increased risk of PCA [odds ratio (OR) = 0.97, 95% confidence interval (CI) 0.59-1.621 among patients with normal renal function (serum creatinine less than or equal to 1.1 mg/ dL). In contrast, digoxin therapy was associated with a modest increase in risk (OR 1.58, Cl 0.89-2.80) among patients with mild renal impairment (serum creatinine = 1.2-1.4 mg/dL); and a twofold increase in risk (OR 2.39, CI 1.37-4.18) among patients with moderate renal impairment (serum creatinine = 1.5-3.5 mg/dL). Conclusions: These findings suggest that the risks of digoxin may offset the benefits among patients with moderately impaired renal function, but not among patients with normal renal function. (C) 2003 Elsevier Inc. All rights reserved.