RESUMO
Clinical outcomes and costs associated with the use of digoxin in atrial fibrillation and flutter were evaluated in a prospective, observational study at 18 academic medical centers in the United States. Data were collected on 115 patients (aged > 18 years) with atrial fibrillation or flutter who were treated with digoxin for rapid ventricular rate (> or = 120 beats/min). The median time to ventricular rate control (i.e., resting ventricular rate < 100 beats/min, decrease in ventricular rate of > 20%, or sinus rhythm) was 11.6 hours from the first dose of digoxin for all evaluable patients (n = 105) and 9.5 hours for those only receiving digoxin (n = 64). Before ventricular rate control, the mean +/- SD dose of digoxin administered was 0.80 +/- 0.74 mg, and a mean of 1.4 +/- 1.8 serum digoxin concentrations were ordered per patient. Concomitant beta-blocker or calcium antagonist therapy was instituted in 47 patients (41%); in 19 of these, combination therapy was initiated within 2 hours. Adenosine was administered to 13 patients (11%). Patients spent a median of 4 days (range 1 to 25) in the hospital; 28% spent time in a coronary/intensive care unit and 79% in a telemetry bed. Loss of control (i.e., resting ventricular rate returned to > 120 beats/min) occurred at least once in 50% of patients and was associated with a longer hospital stay (p < 0.05). Based on 1991 data, the estimated mean hospital bed cost for patients with atrial fibrillation or flutter was $3,169 +/- $3,174.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/economia , Flutter Atrial/tratamento farmacológico , Flutter Atrial/economia , Digoxina/uso terapêutico , Custos de Medicamentos , Hospitais Universitários/economia , Idoso , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/epidemiologia , Flutter Atrial/epidemiologia , Digoxina/economia , Quimioterapia Combinada , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
Rats (eight male, eight female) were trained to lick 32% and 4% sucrose solutions for three minutes per day on four consecutive days. Measures of the number of licks revealed robust positive and negative contrast effects. Analysis of the burst-pause pattern of licking revealed that the decrease in licking characteristic of the negative contrast effect resulted from a decrease in the number of bursts, while the increase in licking characteristic of the positive contrast effect was the result of a shortening of the interburst interval.