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Digitalis in heart failure! Still applicable?

U C Hoppe1, E Erdmann

  • 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
PubMed

Insights

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.

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