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

摘要: 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 had a neutral effect on total mortality. There was evidence mortality caused by worsening failure less, there also signal suggesting an increase other cardiac (presumed arrhythmic) death. Use of substantially recent guideline recommendations have significantly de-emphasized importance this drug management failure. Two developments suggest re-evaluation contemporary role ejection fraction is warranted. First, remains progressive, characterized chronic debility, intolerance, frequent costly hospitalizations, despite evidence-based device therapies prolong survival. Health economics made reducing major priority. Second, strong association emerged between serum concentration safety efficacy digoxin, which indicates change our approach to dosing agent needed. Experimental clinical results optimizing therapeutic benefit avoiding harm means achieve low concentrations (0.5-0.9 ng/mL). inexpensive totality it symptoms safely when dosed concentrations. These findings should more prominent fraction.