A perspective on re-evaluating digoxin's role in the current management of patients with chronic systolic heart failure: targeting serum concentration to reduce hospitalization and improve safety profile

Adams Jr., Kirkwood F., Ghali, Jalal K., Herbert Patterson, J., Stough, Wendy Gattis, Butler, Javed, Bauman, Jerry L., Ventura, Hector O., Sabbah, Hani, MacKowiak, John I. and Van Veldhuisen, Dirk J. (2014) A perspective on re-evaluating digoxin's role in the current management of patients with chronic systolic heart failure: targeting serum concentration to reduce hospitalization and improve safety profile. European Journal of Heart Failure, 16 5: 483-493. doi:10.1002/ejhf.64


Author Adams Jr., Kirkwood F.
Ghali, Jalal K.
Herbert Patterson, J.
Stough, Wendy Gattis
Butler, Javed
Bauman, Jerry L.
Ventura, Hector O.
Sabbah, Hani
MacKowiak, John I.
Van Veldhuisen, Dirk J.
Title A perspective on re-evaluating digoxin's role in the current management of patients with chronic systolic heart failure: targeting serum concentration to reduce hospitalization and improve safety profile
Journal name European Journal of Heart Failure   Check publisher's open access policy
ISSN 1879-0844
1388-9842
Publication date 2014-05-01
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/ejhf.64
Volume 16
Issue 5
Start page 483
End page 493
Total pages 11
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Abstract Digoxin improves exercise tolerance and reduces hospitalizations in patients with systolic heart failure, but its use has declined progressively for the past two decades. The Digitalis Investigation Group trial showed that digoxin reduced hospitalizations but had a neutral effect on total mortality. There was evidence that mortality caused by worsening heart failure was less, but there was also a signal suggesting an increase in other cardiac (presumed arrhythmic) death. Use of digoxin has declined substantially and recent guideline recommendations have significantly de-emphasized the importance of this drug in the management of heart failure. Two developments suggest that re-evaluation of the contemporary role of digoxin in the management of heart failure with reduced ejection fraction is warranted. First, heart failure remains progressive, characterized by chronic debility, exercise intolerance, and frequent and costly hospitalizations, despite evidence-based drug and device therapies that prolong survival. Health economics have made reducing hospitalizations in patients with heart failure a major priority. Second, a strong association has emerged between serum concentration and the safety and efficacy of digoxin, which indicates a change in our approach to dosing this agent is needed. Experimental and clinical results suggest that optimizing therapeutic benefit and avoiding harm means dosing to achieve low serum digoxin concentrations (0.5-0.9 ng/mL). Digoxin is an inexpensive agent and the totality of evidence indicates that it reduces hospitalizations and improves symptoms safely when dosed to achieve low serum concentrations. These findings suggest digoxin should have a more prominent therapeutic role in patients with heart failure and reduced ejection fraction.
Keyword Digoxin
Heart failure
Hospitalization
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2015 Collection
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