Digoxin use in patients awaiting heart transplantation for systolic left ventricular failure

We reviewed the drug therapy of 83 patients who underwent cardiac transplantation for chronic left ventricular cardiac failure in Scotland from 1992-1996. Digoxin had been prescribed to 52% of patients in sinus rhythm, and 82% of those in atrial fibrillation (P=NS). This audit confirms that, in line with the clinical practice in the period between 1992 and 1996, digoxin was not widely used in patients with advanced chronic heart failure who were in sinus rhythm. The publication of the withdrawal trials in 1993 might have been expected to increase the use of digoxin but this could not be demonstrated. The management of patients on the cardiac transplantation waiting list should include the best symptomatic treatment possible. In view of the clinical and experimental evidence of symptomatic improvement by cardiac glycosides, it is to be hoped that publication of the results of the Digitalis Investigation Group trial will improve this situation.