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Digoxin in Heart Failure with a Reduced Ejection Fraction: A Risk Factor or a Risk Marker.

TitleDigoxin in Heart Failure with a Reduced Ejection Fraction: A Risk Factor or a Risk Marker.
Publication TypeJournal Article
Year of Publication2016
AuthorsKonstantinou, D. M., Karvounis H., & Giannakoulas G.
JournalCardiology
Volume134
Issue3
Pagination311-9
Date Published2016
ISSN1421-9751
KeywordsCardiotonic Agents, Digoxin, Heart Failure, Humans, Stroke Volume
Abstract

Digoxin is one of the oldest compounds used in cardiovascular medicine. Nevertheless, its mechanism of action and most importantly its clinical utility have been the subject of an endless dispute. Positive inotropic and neurohormonal modulation properties are attributed to digoxin, and it was the mainstay of heart failure therapeutics for decades. However, since the institution of β-blockers and aldosterone antagonists as part of modern heart failure medical therapy, digoxin prescription rates have been in free fall. The fact that digoxin is still listed as a valid therapeutic option in both American and European heart failure guidelines has not altered clinicians' attitude towards the drug. Since the publication of original Digitalis Investigation Group trial data, a series of reports based predominately on observational studies and post hoc analyses have raised concerns about the clinical efficacy and long-term safety of digoxin. In the present review, we will attempt a critical appraisal of the available clinical evidence regarding the efficacy and safety of digoxin in heart failure patients with a reduced ejection fraction. The methodological issues, strengths, and limitations of individual studies will be highlighted.

DOI10.1159/000444078
Alternate JournalCardiology
PubMed ID26959501

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