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Hauptman PJ, McCann P, Romero JMR, Mayo M. Reference Laboratory Values for Digoxin Following Publication of Digitalis
Investigation Group (DIG) Trial Data. JAMA Intern Med. 2013;173(16):1552–1554. doi:10.1001/jamainternmed.2013.7756
The translation of new findings into clinical practice is an ongoing challenge for physicians and health systems. The definition of a reference range for serum digoxin concentration (SDC) in patients with heart failure provides an example in which published data have not been incorporated into laboratory practice, which as a result may have an adverse impact on clinical care.
Specifically, in a post hoc analysis from the Digitalis Investigation Group (DIG) heart failure trial, higher mean SDCs were associated with increased mortality; the optimal therapeutic range for clinical benefit among men with a left ventricular ejection fraction of less than 45% was 0.5 to 0.8 ng/mL.1 A second analysis indicated that SDCs of 1.2 ng/mL or higher may be harmful in women.2 (To convert digoxin to nanomoles per liter, multiply by 1.281.) In light of these studies, we sought to determine the current practice of reporting SDCs in hospital-based chemical laboratory analyses.
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