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Enalapril versus digoxin in patients with congestive heart failure: a multicenter study. Canadian Enalapril Versus
R F Davies1, D S Beanlands, C Nadeau
1Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada.
Abstract:
Patients with New York Heart Association functional class II or III heart failure stabilized on furosemide therapy were entered into a randomized controlled trial comparing enalapril (n = 72) and digoxin (n = 73). End points were clinical outcome, treadmill exercise capacity and echocardiographic left ventricular dimensions. Improvement in clinical outcome was defined as a reduction of at least one functional class or withdrawal because of an adverse clinical event. After 4 weeks, 13 patients receiving enalapril showed improvement, 55 had no change and 9 manifested deterioration compared with 7, 49 and 17, respectively, in the digoxin group (p less than 0.01). After 14 weeks, 13 patients receiving enalapril showed improvement, 50 had no change and 9 manifested deterioration, compared with 14, 37 and 22, respectively, in the digoxin group (p less than 0.025). More patients in the digoxin group were withdrawn because of an adverse clinical event (p less than 0.05). Exercise time and percent fractional shortening improved in both groups (p less than 0.001 and less than 0.05, respectively), with no significant difference between groups (p greater than 0.50). Both rate-pressure product and subjectively evaluated exertion during submaximal exercise were reduced only in the enalapril group. Although the majority of patients in both groups did well, those receiving enalapril experienced fewer adverse clinical events and had less fatigue during submaximal exercise.
Insights
Enalapril improved clinical outcomes and reduced fatigue in heart failure patients compared to digoxin. While both treatments showed benefits, enalapril led to fewer adverse events and less patient exertion.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Heart failure management often involves optimizing medication regimens.
- Furosemide is a common diuretic for heart failure patients.
- Enalapril and digoxin are established treatments for heart failure.
Purpose of the Study:
- To compare the efficacy of enalapril versus digoxin in patients with heart failure.
- To evaluate clinical outcomes, exercise capacity, and left ventricular dimensions.
- To assess adverse clinical events and patient-reported exertion.
Main Methods:
- Randomized controlled trial involving 145 patients with New York Heart Association functional class II or III heart failure.
- Patients were stabilized on furosemide and randomized to receive either enalapril (n=72) or digoxin (n=73).
- End points assessed included clinical outcome, treadmill exercise capacity, and echocardiographic measures over 14 weeks.
Main Results:
- Enalapril showed a significantly better clinical outcome at 4 and 14 weeks compared to digoxin (p<0.01 and p<0.025, respectively).
- Fewer patients in the enalapril group were withdrawn due to adverse events (p<0.05).
- Both groups improved exercise time and fractional shortening, with no significant difference between enalapril and digoxin. Enalapril uniquely reduced rate-pressure product and perceived exertion.
Conclusions:
- Enalapril demonstrates superior clinical improvement and a better safety profile than digoxin in heart failure patients stabilized on furosemide.
- Enalapril may reduce fatigue during submaximal exercise, contributing to a better overall patient experience.
- Both enalapril and digoxin can improve exercise capacity, but enalapril offers additional benefits in clinical outcomes and adverse event reduction.