Editors:Elham Reshid and Hailemariam Shimelis
Digoxin was approved for heart failure in 1998 (PROVED, RADIANCE, and DIG clinical trials) under current regulations by the Food and Drug Administration. It was also approved for the control of ventricular response rate for patients with atrial fibrillation. It is a safe and well tolerated drug when dosed appropriately. Moreover, it is inexpensive and can be afforded by most patients with heart failure throughout the world.
Most heart failure patients achieve a serum concentration of 0.5 to 1.0ng/mL with doses of 0.125 to 0.25 mg/d.
Digoxin was long known for symptomatic relief and decreased rate of hospitalization. However, data from post hoc analyses of the DIG trial suggest that digoxin reduces mortality at low (0.5–0.9 ng/ml) serum digoxin concen-trations (SDC), but had not effect at higher (≥1 ng/ml) SDC. Digoxin is now also known to suppress sympathetic and renin-angiotensin-aldosterone systems and it has been suggested that the neurohormonal properties of digitalis are more pronounced at low SDC.
The beneficial effects of digoxin at the neurohumoral mechanisms are reducing plasma norepinephrine level
(by improving impaired baroreceptor reflexes in heart failure) and lowering plasma renin levels.
However, it was also suggested that the results of this post hoc analysis of DIG trial should be interpreted with caution. Patients in the DIG trial were younger than real life HF patients and were predominantly male and whites, and had normal sinus rhythm, thus limiting generalizability to other patients. Randomized clinical trials are needed to determine the effect of digoxin in contemporary chronic HF patients.
Different journals discussing the contemporary use of digoxin in the Management of Cardiovascular Disorders, the idea was similar with the DIG trial and they shared similar conclusion. Although digoxin should not be used instead of other heart failure medications with proven mortality benefits, it should be considered an adjunct in all patients with symptomatic heart failure, particularly when heart failure is severe or atrial fibrillation with a rapid ventricular response is present.
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