Macarthur C. Withdrawal of Maintenance Digoxin from Institutionalized Elderly. Postgraduate Medical Journal 1990;66(781):940-42
PubMed link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2429742/
Full text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2429742/pdf/postmedj00167-0055.pdf
| Methods | Study design: Before-and-after study
Number of groups: One group |
| Participants | Number of participants: 14 enrolled, 14 completed
Age: 82.5 years (range 67 to 92 years) Sex: 14 female, 0 male Participants with dementia: No Inclusion criteria: · Maintenance digoxin · Resident of the participating aged care facility Exclusion criteria: · Evidence of atrial fibrillation · Evidence of atrial dysrhythmia Country: Canada Setting: Residential aged care facility – Forest Grove Care Center is a private-for-profit nursing home providing supervised personal care for persons who require assistance in coping with the activities of daily living, but who are not sufficiently ill to warrant general or auxiliary hospital admission |
| Interventions | Medicine: Digoxin
The original reason for prescription of digoxin was known in 5 (36%) of the 14 subjects, with ‘heart failure’ the sole recorded indication. Withdrawal schedule: Not described |
| Outcomes | Successful deprescribing
Clinical outcomes |
| Dates | Dates: Not described
Follow-up duration: 18 months |
| Funding sources | Not described |
| Notes |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | A before-and-after study design. |
| Allocation concealment (selection bias) | High risk | Not concealed. |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | Not blinded. |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | As above. |
| Incomplete outcome data (attrition bias) | 1 out of 5 | No missing data. |
| Selective reporting (reporting bias) | Unclear risk | There is no evidence of a pre-specified protocol and analysis plan, nor is the paper clear in the intended outcomes. |
| Confounding (non-randomized) | 5 out of 5 | There is no concurrent control group. |
| Other bias | High risk | The methods section of the paper has limited detail.
Did not take into account medical history or different cardiac diagnoses. |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | A somewhat representative group of the average person who requires assistance in coping with the activities of daily living, but who are not sufficiently ill to warrant general or auxiliary hospital admission. |
| Selection of the non-exposed cohort | There was no concurrent control group.
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| Ascertainment of exposure | There was no description of whether ascertainment of exposure was determined.
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| Demonstration that outcome of interest was not present at start of study | Demonstrated that outcome of interest was not present at start of study. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The study controlled for digoxin discontinuation. |
| Outcome bias | Assessment of outcome | The assessment of outcome by record linkage. |
| Was follow-up long enough for outcomes to occur | Follow-up was probably long enough for the outcome of interest to occur.
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| Adequacy of follow-up of cohorts | Complete follow-up – all subjects accounted for | |
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