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The Use of Digoxin in Patients with Worsening Chronic Heart Failure Reconsidering an Old Drug to Reduce Hospital Admissions.
J Am Coll Cardiol. 2014 Feb 21;
Authors: Ambrosy AP, Butler J, Ahmed A, Vaduganathan M, van Veldhuisen DJ, Colucci WS, Gheorghiade M
Abstract
Digoxin is the oldest cardiac drug still in contemporary use, yet its role in the management of patients with heart failure (HF) remains controversial. A purified cardiac glycoside derived from the foxglove plant, digoxin increases ejection fraction (EF), augments cardiac output, and reduces pulmonary capillary wedge pressure without causing deleterious increases in heart rate or decreases in blood pressure. Moreover, it is also a neurohormonal modulator at low doses. In the pivotal Digitalis Investigation Group (DIG) trial, digoxin therapy was shown to reduce all-cause and HF-specific hospitalizations but had no effect on survival. With the discovery of neurohormonal blockers capable of reducing mortality in HF with a reduced EF, the results of the DIG trial were viewed as neutral and its use declined precipitously. Although modern drug and device-based therapies have dramatically improved the survival of ambulatory HF patients, outcomes for patients with worsening chronic HF, defined as deteriorating signs and symptoms on standard therapy often leading to unscheduled clinic or emergency room visits or hospitalization, have largely remained unchanged over the last two decades. We critically review the evidence for digoxin, including its limitations, and provide a conceptual framework for future research.
PMID: 24613328 [PubMed - as supplied by publisher]