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Digoxin in heart failure: implications of recent trials
1Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
Journal of the American College of Cardiology
|October 1, 1993
Summary
Cardiac glycosides like digoxin can lessen symptoms and reduce morbidity in congestive heart failure patients, particularly those with advanced ventricular dysfunction. However, evidence for improved survival remains inconclusive, pending further trials.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Cardiac glycosides have a long history of anecdotal use in heart failure.
- Newer heart failure medications prompted reevaluation of cardiac glycoside roles.
- Concerns arose regarding routine digoxin use, especially in patients with normal heart rhythm.
Purpose of the Study:
- To rigorously examine the safety and efficacy of cardiac glycosides in treating systolic heart failure.
- To determine the appropriate role of digoxin in modern cardiovascular medicine.
Main Methods:
- Prospective clinical trials evaluating digoxin in congestive heart failure patients (NYHA class II and III).
- Analysis of trials examining digoxin with or without vasodilators.
- Review of studies maintaining serum digoxin levels between 1-2 ng/ml.
Main Results:
- Digoxin generally lessens symptoms and reduces morbidity in moderate to advanced heart failure.
- Efficacy data for mild heart failure (NYHA class I and II) is less conclusive.
- Current evidence suggests safety and efficacy at therapeutic serum levels, but not improved survival.
Conclusions:
- Digoxin is effective for symptom management and morbidity reduction in specific heart failure populations.
- Improved survival with cardiac glycosides is not yet conclusively demonstrated.
- Ongoing trials, such as the DIG trial, aim to clarify survival benefits.
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