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[Status of digitalis in therapy of acute and chronic heart failure]
1Brigham and Women's Hospital, Department of Medicine, Boston, USA.
Insights
Digitalis may improve heart failure symptoms and reduce hospitalizations, comparable to other treatments. However, current evidence suggests no significant survival benefit for digitalis in heart failure management.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Digitalis has a long history in treating heart failure, but its efficacy was debated.
- Recent clinical trials have re-evaluated its role, particularly in mild to moderate heart failure.
Purpose:
- To assess the efficacy and impact of digitalis on clinical outcomes in heart failure management.
- To explore the complex pharmacology and potential mechanisms of digitalis beyond its inotropic effects.
Summary:
- Clinical trials since 1980 suggest digitalis improves clinical outcomes, especially in advanced heart failure patients with poor left ventricular function.
- While digitalis offers symptomatic relief and reduces hospitalizations, comparable to beta-blockers, diuretics, and ACE inhibitors, it does not appear to confer a survival benefit.
Impact:
- The findings challenge the long-standing use of digitalis, highlighting its role in symptom management rather than mortality reduction.
- This research informs current treatment strategies for heart failure, emphasizing a multi-faceted approach.
Abstract:
Although supported by more than 200 years of experience and anecdotal clinical evidence, the efficacy of digitalis in the management of heart failure has been questioned until the past decade. The idea to improve contractility of the diseased myocardium with an inotropic agent is fundamental in the management of left ventricular dysfunction. The majority of clinical trials published since 1980, most of which examined patients with mild to moderate heart failure, indicate that digitalis alone or in combination with vasodilators may improve the clinical outcome particular in those patients with more advanced symptoms and poorer left ventricular function. Aside from its action as an inotropic drug the pharmacology and the mechanisms by which digitalis influence the diseased myocardium and peripheral circulation in heart failure has gained more complexity within the last years, raising the idea of other mechanisms that might be involved in its action. Particular for ACE inhibition multiple clinical trials have conclusively demonstrated its impact on survival and morbidity in congestive heart failure. Improvement of clinical outcome as measured in terms of fewer hospitalizations and improvement of symptoms in patients receiving digitalis seems to be comparable to patients receiving beta-blockers additional to diuretics and ACE inhibitors, an entirely different approach to the treatment of heart failure. Despite initial improvement of hemodynamics it now appears that there is no survival benefit found for digitalis in the management of heart failure.