Related Experiment Videos
[Comparison of the clinical effect between digoxin and a diuretic in chronic left heart failure and sinus rhythm]
1Innere Abteilung im Auguste-Viktoria-Krankenhaus, Berlin.
Insights
Digoxin and diuretics equally improved chronic heart failure symptoms and exercise tolerance in a 12-week study. Neither treatment significantly altered echocardiographic parameters, suggesting individualized therapy for chronic heart failure (CHF) is best.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Conflicting results exist regarding the optimal initial treatment for chronic left heart failure (CHF) in patients with sinus rhythm.
- Digoxin and diuretics are common therapeutic options for CHF management.
Purpose of the Study:
- To compare the clinical efficacy and safety of digoxin versus a diuretic (hydrochlorothiazide and triamterene) as initial treatment for CHF patients in sinus rhythm.
Main Methods:
- A multicenter, randomized, open-label, 12-week study involving 47 patients with CHF (NYHA class II and III).
- Patients were treated with either digoxin or a combination of hydrochlorothiazide and triamterene.
Main Results:
- Both digoxin and diuretic therapy significantly decreased heart failure scores and improved exercise tolerance.
- No significant differences in clinical efficacy or echocardiographic parameters (ejection fraction, diastolic function indices) were observed between the two groups.
- A small number of patients in both groups required early study termination due to worsening CHF symptoms.
Conclusions:
- Both digoxin and diuretic monotherapy are effective in improving clinical signs of chronic heart failure (CHF).
- The lack of significant differences in efficacy suggests that individualized treatment regimens, rather than a schematic approach, are warranted for managing CHF.
Abstract:
Because of conflicting results from studies examining the initial treatment of patients with chronic left heart failure (CHF) and sinus rhythm, the clinical efficacy and safety of digoxin and a diuretic were compared in a multicenter, randomised, open twelve-week study. 47 patients with CHF (NYHA II and III) were treated either with digoxin or a combination of hydrochlorothiazide and triamterene. Three patients from the diuretic group and four from the digoxin group required premature termination of study periods because of increasing symptoms of CHF. Both regimens decreased significantly a heart failure score and increased distinctly the symptom-limited exercise tolerance, but results did not differ between the groups. Echocardiographic parameters, ejection fraction and radionuclide indices of diastolic function estimated by gated blood pool scan did not change with either treatment. It was concluded that digoxin or the diuretic therapy alone was effective in ameliorating the clinical signs of CHF. Due to missing differences in the clinical efficacy of both drugs an individual and not schematic treatment regimen of CHF is warranted.