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Digitalis in heart failure! Still applicable?
1Department of Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. uta.hoppe@uni-koeln.de
Zeitschrift Fur Kardiologie
|May 4, 2005
Summary
Cardiac glycosides, like digitalis, can help heart failure patients with sinus rhythm. Low serum concentrations are key for benefits, with no sex-based differences in effectiveness, making them a viable option regardless of gender.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Cardiac glycosides are used for heart failure with atrial fibrillation to control ventricular rate.
- The use of digitalis in systolic heart failure with sinus rhythm remains debated, with concerns about increased mortality in women.
Purpose of the Study:
- To evaluate the effectiveness and safety of cardiac glycosides in patients with heart failure and sinus rhythm.
- To investigate potential sex-based differences in cardiac glycoside effectiveness.
- To determine optimal serum digoxin concentrations for therapeutic benefit.
Main Methods:
- Retrospective analysis of patient data.
- Examination of cardiac glycoside effectiveness and mortality rates.
- Assessment of serum digoxin concentrations and their correlation with outcomes.
Main Results:
- Retrospective analyses show no sex-based differences in cardiac glycoside effectiveness.
- Beneficial effects are linked to low serum digoxin concentrations (0.5-0.8 ng/ml), associated with attenuated sympathetic activation.
- High serum levels correlate with increased mortality.
Conclusions:
- Cardiac glycosides should be considered for symptomatic heart failure patients with sinus rhythm, even with optimal ACE inhibitor, beta-blocker, and diuretic therapy.
- Therapy should aim for low target serum digoxin concentrations (0.5-0.8 ng/ml) irrespective of patient gender.
- Digitalis offers benefits through neurohumoral modulation at therapeutic concentrations.