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[Digitalis, a drug to be scrapped?]
Franco Cosmi1, Barbara Tarquini1, Beatrice Mariottoni1
1Dipartimento Cardiovascolare e Neurologico, Cardiologia Valdichiana, USL 8, Arezzo.
Giornale Italiano Di Cardiologia (2006)
|April 12, 2017
Summary
Digoxin offers no mortality benefit for heart failure patients and may increase risks in atrial fibrillation. Current guidelines lack strong evidence, suggesting a need for new trials to confirm efficacy and safety.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Digoxin is frequently prescribed for heart failure and atrial fibrillation.
- Evidence supporting its use is limited, particularly in contemporary clinical practice.
Purpose of the Study:
- To review the scientific literature on digoxin's efficacy and safety in heart failure and atrial fibrillation.
- To evaluate the evidence base for current clinical guidelines regarding digoxin use.
Main Methods:
- Comprehensive literature review of randomized trials, observational studies, and meta-analyses.
- Analysis of existing clinical guidelines from European and American bodies.
Main Results:
- The DIG trial showed neutral mortality but reduced hospitalizations in systolic heart failure patients in sinus rhythm (pre-beta-blocker era).
- No randomized trials exist for atrial fibrillation; observational data suggest a ~20% increase in mortality with digoxin.
- Guideline recommendations often rely on expert opinion rather than robust trial data.
Conclusions:
- Digoxin use in heart failure and atrial fibrillation is based more on tradition than evidence.
- New randomized controlled trials are needed to establish efficacy and safety.
- Current practice should consider withdrawing digoxin until further evidence emerges, maintaining digoxin levels <1 ng/ml to avoid toxicity.