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[Use of digitalis in geriatrics: is it effective on the heart in sinus rhythm?]
Insights
Digoxin is not necessary for elderly patients with normal heart rhythm. Alternative treatments like salt restriction and diuretics are suggested for managing fluid retention in these patients.
Area of Science:
- Cardiology
- Geriatric Medicine
Background:
- Digitalis, including digoxin, is known for its positive inotropic effects and use in atrial fibrillation.
- The utility of chronic digoxin stimulation in elderly individuals with normal sinus rhythm is uncertain.
Purpose of the Study:
- To evaluate the necessity of chronic digoxin use in aged subjects with sinus rhythm.
- To assess the impact of digoxin on cardiac function and clinical parameters in the elderly.
Main Methods:
- A 3-month randomized, placebo-controlled trial involving 35 elderly subjects (mean age 76.5 years) in sinus rhythm.
- Subjects, predominantly on long-term digoxin, were divided into digoxin and placebo groups.
- Clinical and instrumental parameters, including NYHA heart function classification, were assessed.
Main Results:
- No significant differences were observed between the digoxin and placebo groups over the 3-month study period.
- Digoxin did not demonstrate a significant benefit for cardiac control in this cohort.
- Hydrosaline retention management strategies were explored.
Conclusions:
- Chronic digoxin therapy is not essential for managing elderly patients in sinus rhythm.
- Salt restriction, rest, and diuretics may effectively manage hydrosaline retention in this population.
- Findings align with recent literature questioning the routine use of digitalis in elderly sinus rhythm patients.
Abstract:
The therapeutic activity of digitalis in cardiac failure is linked to its positive inotropic effect on the myocardium and its ability to control cardiac activity in atrial fibrillation. Chronic stimulation with digoxin in aged subjects with sinus rhythm, however, is of debatable utility Reference is made to a series of 35 subjects (mean age 76.5 yr) in sinus rhythm, 30 of whom had been taking digoxin for over 3 yr. Clinical and instrumental parameters were assessed and heart function was classified according to the NYHA arrangement. Subjects were randomly placed in two groups matched for sex, age and cardiac condition. The first group received digoxin, the second a placebo. No significant differences between the two groups were noted over a 3-month period. In keeping with the recent literature, it is felt that digitalis is not necessary for the dynamic cardiac control of aged subjects in sinus rhythm. In addition, it is suggested that hydrosaline retention in such subjects can be controlled by restriction of salt intake, rest and diuretics.