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Is there a role for digoxin in patients with systolic dysfunction?
1Division of Pharmacy Practice, University of North Carolina, Chapel Hill School of Pharmacy 27599-7360, USA.
Insights
Digoxin benefits heart failure patients by improving symptoms and exercise capacity. Continued use maintains stability, but optimal patient selection and effects with ACE inhibitors require further study.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Digoxin demonstrated benefits in early heart failure trials, improving hemodynamics and exercise capacity.
- Withdrawal of digoxin in stable patients on diuretics and ACE inhibitors often led to deterioration.
Purpose of the Study:
- To summarize the established and emerging roles of digoxin in heart failure management.
- To highlight areas needing further investigation regarding digoxin use.
Main Methods:
- Review of early placebo-controlled trials.
- Analysis of a recent trial assessing digoxin withdrawal.
Main Results:
- Digoxin improved hemodynamics, symptoms, and exercise capacity in early trials.
- Continuing digoxin maintained clinical stability in patients on diuretics and ACE inhibitors.
Conclusions:
- Digoxin remains a valuable agent for heart failure symptom management.
- Further research is needed to define initial treatment strategies and mortality effects with ACE inhibitors.
Abstract:
In early placebo-controlled trials in patients with heart failure who were in sinus rhythm, digoxin improved hemodynamics, signs and symptoms of heart failure, and exercise capacity, and decreased functional deterioration and the need for pharmacologic cointervention. A more recent trial showed that withdrawing digoxin from patients who were clinically stable while receiving diuretics and angiotensin-converting enzyme (ACE) inhibitors often resulted in clinical deterioration, whereas continuing the agent maintained stability. Which patients should initially be treated with digoxin remains to be determined. The effects of digoxin on mortality in patients who are receiving ACE inhibitors must also be established.