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Digoxin use in congestive heart failure. Current status

K Riaz1, A D Forker

  • 1Department of Internal Medicine, University Missouri-Kansas City, School of Medicine, USA.

Drugs
|June 9, 1998
PubMed

Insights

Digoxin helps manage mild heart failure by preventing clinical decline and hospitalizations, improving exercise capacity, and enhancing heart function, without impacting survival rates. This digitalis medication offers benefits even at lower doses.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • The efficacy of digitalis (digoxin) in treating congestive heart failure (CHF) with normal sinus rhythm remains a subject of ongoing debate.
  • Historical studies provided limited, often uncontrolled data, hindering definitive conclusions on digoxin's benefits and risks.

Purpose of the Study:

  • To critically evaluate the evidence for digoxin's use in heart failure, focusing on clinical outcomes, survival, and specific patient subgroups.
  • To assess the impact of digoxin on exercise tolerance, left ventricular function, and neurohormonal effects in heart failure patients.

Main Methods:

  • Review of historical uncontrolled studies (1969-1983) and higher-quality randomized, double-blind, placebo-controlled trials (1977-1991).
  • Analysis of major trials including the Prospective Randomised Study of Ventricular Failure and Efficacy of Digoxin (PROVED), Randomised Assessment of Digoxin on Inhibitors of the Angiotensin-Converting Enzyme (RADIANCE), and the Digitalis Investigation Group (DIG) trial.
  • Inclusion of a DIG trial substudy examining digoxin's effect on survival in patients with preserved ejection fraction (diastolic dysfunction).

Main Results:

  • Digoxin was shown to prevent clinical deterioration and reduce hospitalizations in heart failure patients.
  • The drug improves exercise tolerance and left ventricular function.
  • Crucially, digoxin demonstrated no adverse effect on survival rates, even in patients with ejection fraction > 45% (diastolic dysfunction).
  • Evidence suggests a potential neurohormonal effect of digoxin, possibly at doses lower than 0.25 mg, particularly benefiting patients with mild heart failure.

Conclusions:

  • Digoxin is the first inotropic agent demonstrated to improve heart failure outcomes without negatively impacting survival.
  • The drug is beneficial for patients with mild heart failure and diastolic dysfunction.
  • Further research into lower-dose digoxin and its neurohormonal mechanisms is warranted.

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