Is foxglove effective in heart failure?

Area of Science:

• Cardiology
• Pharmacology

Background:

• Digoxin is an established heart failure (HF) treatment, historically reducing HF admissions in patients with preserved ejection fraction.
• Current guidelines suggest digoxin for symptomatic HF despite optimal therapies, based on older trial data.
• Digoxin's use predates modern mortality-reducing HF treatments, necessitating a review of its efficacy and safety.

Purpose of the Study:

• To review historical and contemporary data on digoxin's efficacy and safety in heart failure (HF).
• To assess the current evidence base for digoxin as an add-on therapy in HF management.

Main Methods:

• Conducted multiple PubMed searches using terms like "digoxin," "heart failure," "efficacy," and "safety."
• Included randomized controlled trials and observational studies, excluding irrelevant or non-English articles.
• Manually searched reference lists of relevant articles for additional studies.

Main Results:

• Retrieved three randomized controlled trials and three large observational reports on digoxin in HF with sinus rhythm.
• Reviewed additional studies involving patients with HF and atrial fibrillation.
• Identified a lack of definitive randomized trials comparing digoxin with modern HF therapies.

Conclusions:

• Definitive randomized evidence for digoxin's efficacy as add-on HF therapy is lacking.
• Unanswered questions persist regarding optimal digoxin dosage and potential harm in some HF patients.
• Conflicting findings from observational studies highlight the need for further investigation into digoxin's role in HF.