Digitalis in the elderly

Since William Withering first described the use of digitalis, over 200 years ago (1), its popularity has waxed and waned. Digitalis preparations are widely prescribed for elderly patients. Surveys of hospital in-patients have shown a high prevalence of the use of digitalis preparations (2, 3), but also of digitalis toxicity; though not all studies have shown the latter to increase with age. A survey of people aged 70, living in Gothenberg, showed that 14% were taking digitalis preparations (4); other studies have shown similar figures. Now that powerful diuretics and vasodilators are available for the treatment of heart failure, and many antiarrhythmics are used for the control of atrial tachyarrhythmias, there is controversy about the value of cardiac glycosides in the treatment of elderly patients.