Related Experiment Videos
Heart failure in outpatients: a randomized trial of digoxin versus placebo
Insights
Digoxin may benefit selected heart failure patients without atrial fibrillation. A study found that patients with a third heart sound and persistent symptoms showed improvement with digoxin.
Area of Science:
- Cardiology
- Pharmacology
Background:
- The clinical benefit of digitalis (digoxin) in patients with heart failure and normal sinus rhythm is not well-established by controlled studies.
- Previous research has yielded conflicting results regarding digoxin's efficacy in this patient population.
Purpose of the Study:
- To evaluate the clinical effects of oral digoxin compared to placebo in outpatients with heart failure and sinus rhythm.
- To identify patient characteristics that predict a positive response to digoxin therapy.
Main Methods:
- A randomized, double-blind, crossover study design was employed.
- Twenty-five outpatients with heart failure and without atrial fibrillation participated.
- Clinical and echocardiographic assessments, including right-heart catheterization in some cases, were used to evaluate treatment response.
Main Results:
- Digoxin reduced heart failure severity in 14 out of 25 patients, with improvement confirmed in nine.
- Patients who responded to digoxin typically had more chronic, severe heart failure, left ventricular dilation, depressed ejection fraction, and a third heart sound.
- The presence of a third heart sound was the strongest predictor of digoxin response (P < 0.0001).
Conclusions:
- Long-term digoxin therapy can be clinically beneficial for heart failure patients in sinus rhythm who have a third heart sound and persistent symptoms despite diuretic treatment.
- The third heart sound is a key indicator for identifying patients likely to benefit from digoxin.
- This study provides evidence supporting the targeted use of digoxin in specific heart failure subgroups.
Abstract:
The view that digitalis clinically benefits patients with heart failure and sinus rhythm lacks support from a well-controlled study. Using a randomized, double-blind, crossover protocol, we compared the effects of oral digoxin and placebo on the clinical courses of 25 outpatients without atrial fibrillation. According to a clinicoradiographic scoring system, the severity of heart failure was reduced by digoxin in 14 patients; in nine of these 14, improvement was confirmed by repeated trials (five patients) or right-heart catheterization (four patients). The other 11 patients had no detectable improvement from digoxin. Patients who responded to digoxin had more chronic and more severe heart failure, greater left ventricular dilation and ejection-fraction depression, and a third heart sound. Multivariate analysis showed that the third heart sound was the strongest correlate of the response to digoxin (P less than 0.0001). These data suggest that long-term digoxin therapy is clinically beneficial in patients with heart failure unaccompanied by atrial fibrillation whose failure persists despite diuretic treatment and who have a third heart sound.