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Maintenance digoxin after an episode of heart failure: placebo-controlled trial in outpatients
Insights
Maintenance digoxin treatment is crucial for heart failure patients, as stopping it led to clinical deterioration and worsened lung function. Reintroducing digoxin improved outcomes, indicating sustained benefits.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Digoxin is commonly prescribed for heart failure.
- The necessity of maintenance digoxin therapy requires further investigation.
Purpose of the Study:
- To assess the need for maintenance digoxin treatment in heart failure patients.
- To evaluate the effects of discontinuing digoxin on clinical status and spirometric values.
Main Methods:
- A double-blind, variable-dose, crossover study comparing digoxin to placebo.
- Inclusion of 46 outpatients with heart failure, categorized by heart rhythm (sinus rhythm or atrial fibrillation).
- Monitoring of clinical status, spirometric values, and serum digoxin concentrations.
Main Results:
- Sixteen out of 46 patients deteriorated when switched to placebo, with eight showing complete recovery upon digoxin reintroduction.
- Temporary diuretic use was needed for patients who did not fully recover after placebo.
- Spirometric values declined on placebo, irrespective of clinical heart failure recurrence.
- In a subset of patients, digoxin reintroduction shortened left ventricular ejection time, suggesting sustained inotropic effects.
Conclusions:
- Maintenance digoxin therapy is essential for managing heart failure.
- Discontinuation of digoxin can lead to clinical deterioration and impaired respiratory function.
- The inotropic response to digoxin is sustained during maintenance treatment.
Abstract:
The need for maintenance digoxin treatment was assessed in a double-blind, variable-dose, crossover comparison with placebo. Forty-six outpatients who had been prescribed the drug for heart failure were studied; 33 were in sinus rhythm and the remainder in atrial fibrillation. Mean serum digoxin concentrations in those with sinus rhythm averaged 1-33 nmol/l, but a lower concentration, averaging 0-97 nmol/l, was accepted in those with atrial fibrillation as six of them developed bradycardia. Sixteen of the 46 patients deteriorated on placebo, and eight completely recovered when digoxin was reintroduced; in the remainder additional diuretics were required temporarily. Spirometric values deteriorated on changing to placebo whether or not the patient showed clinical evidence of recurrence of heart failure. In a separate study of nine patients who showed no clinical evidence of deterioration on placebo, reintroduction of digoxin caused a shortening of left ventricular ejection time, which persisted for at least a month. This suggests that the inotropic response to digoxin is sustained during maintenance treatment.