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Challenges for the Basis of Practice

The Contemporary Use of Digoxin for the Treatment of Heart Failure

Gary S. Francis, MD

From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

Correspondence to Gary S. Francis, MD, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk F-15, Cleveland, Ohio 44195. E-mail francig@ccf.org

Received July 11, 2008; accepted July 14, 2008.

Key Words: diagnosis • drugs • digoxin

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The use of digitalis has been plagued by controversy since its initial use by Withering in 1775. We now have much more data,¹ but it should be remembered that the Digitalis Investigator Group trial was executed when β-blockers were not widely used to treat heart failure. There are still many questions about where we currently stand with the use of digitalis. Specifically, when should one add digoxin to the medical regimen of a patient with heart failure symptoms? Another question that frequently arises is whether one should consider stopping digoxin in a patient referred for care who has chronic stable heart failure. I will briefly examine these 2 scenarios separately.

Should One Add Digoxin to a Medical Regimen in Patients With Heart Failure?
When faced with a patient demonstrating worsening symptoms of heart failure, we are trained to ask, "why is this patient worse?" Sometimes the answer is apparent, but often it is unclear. When heart failure worsens and patients begin to have more signs and symptoms, a remedial cause should be sought and corrected when possible. Often the cause is dietary indiscretion, noncompliance with medications, comorbid conditions, and unclear or misunderstood instructions about how to self-manage the condition of heart failure. However, complications directly related to the heart, such as myocardial ischemia, myocardial infarction, or arrhythmias, can occur. We know that paroxysmal and permanent atrial fibrillation (AF) occurs in a substantial proportion of patients with heart failure during the course of their illness, probably in the range of 20% to 30%. One should always consider AF as a potential cause of worsening . . . [Full Text of this Article]