Digitalis: Should It Be Used in Heart Failure?

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The introduction of new classes of positively inotropic drugs over the past two decades had engendered optimism that newer pharmacologic approaches to the treatment of systolic ventricular dysfunction would prove safer and more efficacious than the digitalis glycosides, Indeed, although supported by more than 200 yr of aoecdetal clinical evidence no ngorous prospective clinical trials designed to document the efficacy and safety of digitalis compounds were performed until relatively recently while most clnicians continue to view the use of a digitalis glycoside as appropriate in patient with congestive heart failure complicated by atrial fibrillation or other supraventicular tachyarrhythmias much controvers has centered on their role in the majority of heart failure patients who are in sinusrththm it is now apparent that most prospective clinical trials reported over the past 10 yr indicate that the use on cardiac glycosides—specifically digoxin in these trials—confers clinical benefit in patients with moderate to sever congestive heart failure eye when added to therapy with masodilators and diurehes. The important question of whether cardiac glycosides improve or worsen mortaldy of heart failure patients is the subject of an ongoing multicenter trial sponsored by the National Institutes of Health.

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