Related Experiment Video

Updated: Jul 3, 2026

A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
04:24

A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program

Published on: April 19, 2019

[The digitalis: should we forget it?]

Salvatore Greco1, Lanfranco Antonini, Antonio Auriti

  • 1Dipartimento di Malattie Cardiache, Ospedale San Filippo Neri, Roma. salvatore.greco@gmail.com

Giornale Italiano Di Cardiologia (2006)
|August 6, 2008
PubMed

Insights

Digitalis remains effective for heart failure treatment, despite declining prescriptions. Optimal blood levels (digoxinemia) of 0.5-0.9 ng/ml show mortality benefits, warranting updated treatment guidelines.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Digitalis has been a cornerstone treatment for heart failure and atrial fibrillation for over two centuries.
  • Prescription rates for digitalis have significantly declined, contrasting with newer cardiovascular medications.
  • The declining commercial interest from pharmaceutical companies impacts the perceived value and research into digitalis.

Purpose of the Study:

  • To re-evaluate the efficacy of digitalis in treating heart failure.
  • To analyze the impact of digoxin blood levels on patient outcomes.
  • To advocate for updated clinical guidelines regarding digitalis prescription and therapeutic ranges.

Main Methods:

  • Analysis of prescription trends from the IN-CHF Italian registry (1995-2005).
  • Review of the Digitalis Investigation Group (DIG) trial (1997) findings.
  • Evaluation of post-hoc analyses examining the relationship between digoxinemia and mortality.

Main Results:

  • Digitalis prescriptions decreased from 63.3% (1995-1999) to 40% (2000-2005).
  • The DIG trial demonstrated no mortality benefit but reduced hospital admissions for heart failure.
  • Post-hoc analyses indicated improved mortality with digoxinemia levels between 0.5-0.9 ng/ml.

Conclusions:

  • Digitalis should continue to be considered an effective treatment for heart failure.
  • Current prescription practices and therapeutic digoxinemia ranges require updating.
  • Evidence supports the benefit of digitalis at specific blood concentrations, particularly for reducing hospitalizations and potentially improving survival.

Related Concept Videos

Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers01:24

Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers

Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which indirectly block calcium...
Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers01:20

Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers

Class IV antiarrhythmic drugs, such as verapamil and diltiazem, block calcium channels. They primarily affect the heart, slowing the conduction in calcium-dependent tissues like the SA and AV nodes. These drugs manage reentrant supraventricular tachycardia (SVT) and reduce ventricular rate in atrial flutter/fibrillation.
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers01:12

Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers

Class III antiarrhythmic drugs are a group of medications that can prolong action potentials in the heart. They achieve this by blocking potassium channels or enhancing inward currents from sodium channels. However, these drugs have a unique property of "reverse use-dependence," which is most pronounced at slower heart rates and can lead to torsades de pointes—a specific type of arrhythmia. However, it is essential to note that excessive QT interval prolongation—a measure of the heart's...
Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...