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Contemporary indications and therapeutic implications for digoxin use
Mayank K Mittal1, Priya Chockalingam, Anand Chockalingam
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA. mittalm@health.missouri.edu
Insights
Digoxin remains a valuable treatment for heart failure (HF) patients experiencing symptoms despite standard therapies and for managing atrial fibrillation. This review highlights its underuse and continued importance in cardiac care.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure (HF) significantly contributes to morbidity and mortality.
- Standard HF therapies include ACE inhibitors and beta-blockers, but digoxin's role is debated.
- Digoxin is recommended for symptomatic HF and atrial fibrillation rate control.
Purpose of the Study:
- To conduct a systematic literature review on current indications for digoxin.
- To highlight clinical settings where digoxin is indicated, despite its underuse.
- To emphasize digoxin's continued relevance in acute and chronic cardiac conditions.
Main Methods:
- Systematic literature search for current digoxin indications.
- Review of existing research and safety data on digoxin.
- Analysis of clinical settings where digoxin is recommended.
Main Results:
- Digoxin is prescribed 20 million times annually in the US.
- The drug exhibits favorable hemodynamic effects in HF and atrial tachyarrhythmias.
- Despite evidence, digoxin is suggested to be underused in clinical practice.
Conclusions:
- Digoxin is indicated for symptomatic HF patients and atrial fibrillation rate control.
- Challenges exist in prospective studies for acute HF, yet digoxin's role persists.
- Digoxin is crucial for optimizing care in specific acute and chronic cardiac conditions.
Abstract:
Heart failure (HF) is a leading cause of morbidity and mortality. Appropriate medical therapy using angiotensin converting enzyme inhibitors and beta-blockers improves outcomes in HF, whereas the role of digoxin is still not clearly defined. Digoxin is currently recommended for patients with HF who are symptomatic despite standard therapy and for controlling the ventricular rate in atrial fibrillation. Digoxin is a time-tested drug that accounts for 20 million drug prescriptions annually in the United States. It has favorable hemodynamic effects for patients with HF and atrial tachyarrhythmias. We conducted a systematic literature search for the current indications for digoxin. Despite extensive research and safety data, the literature suggests that digoxin is underused in clinical settings. Citing the literature where available, our review highlights the various clinical settings where digoxin is indicated. Despite difficulties with designing prospective studies in acute HF settings and lack of outcomes data, we believe that digoxin will continue to serve an important role in optimizing care in certain acute and chronic cardiac conditions.
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