Digoxin and mortality in atrial fibrillation

Using propensity score-matched controls, post hoc subgroup analysis of the ARISTOTLE trial showed an independent dose-dependent association between serum digoxin levels and mortality in those receiving digoxin, with a 19% higher adjusted hazard of death for each increase of 0.5 ng/mL (P = .001). For those initiating digoxin there was an independent association with higher mortality, regardless of heart failure (adjusted hazard ratio, 1.78; 95% confidence interval, 1.37-2.31; P less than .0001).

Citation: Lopes RD et al. Digoxin and mortality in patients with atrial fibrillation. J Am Coll Cardiol. 2018 Mar 13;71(10):1063-74.

ED opioid overdoses

Prior studies have shown a recent increase in opioid overdose-related deaths, and this analysis of 136 million ED visits in 45 states showed a continued upward trend from July 2016 to September 2017 with average increases of 5.6% per quarter in all regions and across all demographic groups, but this increase was especially pronounced in urban areas. The authors of this analysis called for the medical community to use these data to educate providers and organize resources for the rapidly evolving opioid epidemic.

Citation: Vivolo-Kantor AM et al. Vital signs: Trends in emergency department visits for suspected opioid overdoses – United States, July 2016-September 2017. MMWR Morb Mortal Wkly Rep. 2018;67:279-85.

Routine oxygen therapy in patients with acute MI with normal oxygen saturation levels has no benefit

A large meta-analysis showed no decrease in all-cause mortality, recurrent ischemia, or myocardial infarction, heart failure, and arrhythmia from using routine oxygen therapy in patients with acute myocardial infarction with normal oxygen saturation levels. This meta-analysis confirmed prior studies and supported the changing trend in recommendations to avoid supplemental oxygen in patients with peripheral oxygen saturations greater than 90%.

Citation: Abuzaid A et al. Oxygen therapy in patients with acute myocardial infarction: A systemic review and meta-analysis. Am J Med. 2018 Jun;131(6):693-701.

Predicting hospitalization for acute kidney injury

Data from the 2000-2014 National Inpatient Sample and National Health Interview Surveys indicated that people with diabetes are nearly four times more likely to have acute kidney injury-related hospitalization than are people without. The analysis may have limitations for multiple admissions being counted several times, underestimation of prevalence of acute kidney injury, increased awareness regarding acute kidney injury, and unknown effects of type and duration of diabetes.

Citation: Pavkov ME et al. Trends in hospitalization of acute kidney injury – United States, 2000-2014. MMWR. 2018 Mar 16;67(10):289-93.