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CLARIFYING THE ROLE OF DIGOXIN IN HEART FAILURE.

Once a mainstay of treatment for heart failure, digoxin has recently taken a back seat to newer therapies such as ACE inhibitors. This multicenter trial sought to determine, once and for all, whether digoxin reduces morbidity or mortality.

Researchers randomized 6800 patients with heart failure to receive digoxin (usually 0.25 mg daily) or placebo. The mean ejection fraction was 28 percent; two-thirds of the patients were in New York Heart Association class I and II, and one-third were in class III. Two-thirds had ischemic cardiomyopathy and a previous myocardial infarction. Nearly all patients also took diuretics and ACE inhibitors.

During an average follow-up of 37 months, overall and cardiovascular mortality rates were almost identical in the two groups. But compared with the placebo group, the digoxin group had a modest but significant reduction in the proportion of patients hospitalized for any cause (67 vs. 64 percent) or for cardiovascular causes (54 vs. 50 percent). The overall number of hospitalizations was also reduced in the digoxin group.

Comment: It is reasonable to assume that hospitalization was a surrogate marker for worsening symptoms in this study. Thus, digoxin still appears to have a role, albeit limited, in the treatment of heart failure.

— AS Brett

Published in Journal Watch General Medicine February 28, 1997

Citation(s):

The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997 Feb 20 336 525-533.

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