Abstract
Digitalis plays an important role in the treatment of patients in whom systolic dysfunction is a major component. Although its therapeutic benefits were demonstrated more than two centuries ago, the efficacy of digitalis in the treatment of patients in normal sinus rhythm with heart failure has remained controversial. Further, beneficial effects beyond a direct inotropic or hemodynamic benefit may account for much of the clinical outcome in humans. The absence of a significant reduction in mortality in a large prospective trial (Digitalis Investigation Group [DIG] trial) is balanced against the clinical benefit demonstrated in two independent digoxin withdrawal studies.
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References
Kelly RA, Smith TW: Treatment of stable heart failure: digitalis and diuretics. In Atlas of Heart Diseases, vol IV. Heart Failure: Cardiac Function and Dysfunction. Edited by Colucci WS, Braunwald E. Philadelphia: Current Medicine; 1995:10. 1–10. 16.
Wilcox CS, Mitch WE, Kelly RA, et al.: Response to furosemide: I. Effect of salt intake and renal compensation. J Lab Clin Med 1983, 102: 450–458.
Sica DA, Deedwania P: Pharmacotherapy in congestive heart failure: principles of combination diuretic therapy in congestive heart failure. Congestive Heart Failure 1997, 3: 29–38.
Vargo D, Kramer WG, Black PK, et al.: The pharmacodynamics of torsemide in patients with congestive heart failure. Clin Pharmacol Ther 1994, 56:48–54.
Rudy DW, Gehr TWB, Matzke G, et al.: The pharmacodynamics of intravenous and oral torsemide in patients with chronic renal insufficiency. Clin Pharmacol Ther 1994, 56:39–47.
Brater DC: Diuretic therapy. N Engl J Med 1998, 339: 387–395.
Cody RJ, Pickworth KK: Approaches to diuretic therapy and electrolyte imbalance in congestive heart failure. In Update in Congestive Heart Failure: Cardiology Clinics, vol 12. Edited by Deedwania PC. Philadelphia: WB Saunders; 1994: 37–50.
Mason DT, Braunwald E, Karsh RB, et al.:Studies on Digitalis: X. Effects of ouabain on forearm vascular resistance and venous tone in normal subjects and in patients in heart failure. J Clin Invest 1964, 43:532–543.
Ferguson DW, Berg WJ, Sanders JS, et al.: Sympathoinhibitory responses to digitalis glycosides in heart failure patients: direct evidence from sympathetic neural recordings. Circulation 1989, 80:65–77.
Wang W, Chen J-S, Zucker IH: Carotid sinus baroreceptor sensitivity in experimental heart failure. Circulation 1990, 81: 1959–1966.
Gheorghiade M, St Clair J,St Clair C, et al.: Hemodynamic effects of intravenous digoxin in patients with severe heart failure initially treated with diuretics and vasodilators. J Am Coll Cordial 1987, 9:849–857.
Captopril-Digoxin Multicenter Research Group: Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. JAMA 1988, 259: 539–544.
Uretsky BF, Young JB, Shahidi FE, et al.: Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: results of the PROVED trial. J Am Coll Cordial 1993, 22:955–962.
Packer M, Gheorghiade M, Young JB, et al.:Withdrawal of digoxin from patients with chronic heart failure treated with angiotensinconverting-enzyme inhibitors. N Engl J Med 1997, 329:1–7.
Digitalis Investigation Group: The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group (DIG) Trial. N Engl J Med 1997, 336: 525–533.
Lader E, Egan D, Hunsberger S, et al.:The effect of digoxin on the quality of life in patients with heart failure. J Card Fail 2003, 9:4–12.
Rathore SS, Curtis JP, Wang Y, et al.: Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 2003, 289:871–878.
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Bradley, D., Dyke, S., Cody, R.J. (2005). Diuretics and Digitalis. In: Colucci, W.S. (eds) Atlas of HEART FAILURE. Current Medicine Group, London. https://doi.org/10.1007/978-1-4757-4558-0_10
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DOI: https://doi.org/10.1007/978-1-4757-4558-0_10
Publisher Name: Current Medicine Group, London
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