Clinical Characteristics and Outcomes of Patients With Chronic Digoxin Toxicity Presenting to the Emergency Department

Purpose: Digoxin is widely used to treat heart failure and atrial fibrillation but has a narrow therapeutic index, making elderly patients particularly susceptible to chronic toxicity. Because its clinical manifestations are often nonspecific, diagnosis in the emergency department (ED) may be delayed. To evaluate the demographic characteristics, clinical presentation, electrocardiographic findings, laboratory parameters, and in-hospital outcomes of patients presenting to the ED with chronic digoxin toxicity.Methods: This retrospective cohort study included adult patients admitted to a tertiary-care ED over a five-year period who received chronic digoxin therapy and had serum digoxin levels ≥2,0 ng/mL. Patients with acute intentional overdose or incomplete medical records were excluded. Demographic characteristics, comorbidities, presenting symptoms, Electrocardiogram (ECG) findings, laboratory results, and in-hospital outcomes were analyzed.Results: A total of 188 patients were included (mean age 73,50±12,10 years; 42,00% male). Dyspnea (35,10%), chest pain (23,40%), and nausea/vomiting (22,90%) were the most common presenting symptoms. Heart failure (76,60%) and hypertension (71,30%) were the most frequent comorbidities. Valvular heart disease was more common in patients aged ≤ 65 years (p=0,005), whereas serum sodium levels were higher in older patients (r=0,282, p<0,001). Serum digoxin levels correlated positively with potassium, urea, creatinine, creatine kinase–myocardial band (CK-MB), and troponin, and negatively with hemoglobin. Higher digoxin concentrations were associated with increased in-hospital mortality (p=0,006).Conclusion: Chronic digoxin toxicity is an important and frequently under-recognized condition in the ED. Early recognition based on clinical, laboratory, and ECG findings may improve patient outcomes.