Digitalis in the treatment of heart failure with sinus rhytm.

Abstract

Digitalis has been used in the treatment of heart failure for more than 200 years. The role of the drug has been strongly debated. I have tried to figure out if the drug is useful, damaging or if the drug has a role at all in the treatment of heart failure with sinus rythm.

To get these answers I have carried out a litterary study.

Early withdrawal trials (1993) concluded that withdrawal of digitalis meant increased probability of worsening of heart failure, lower score of quality of life, decreased EF, increased HR and increased weight.

The DIG trial is the biggest and most impressive trial concerning this drug. About 7000 patients participated. Digitalis showed to have a positive effect on hospitalization, but not on mortality. After this trial, several followed using the DIG data. One found that there were differences between the sexes. There were increased mortality among women.

A very interesting finding were also detected using the DIG data. There were in fact a significant decrease in mortality among patients with low serum digoxin concentrations.

After writing this paper, my conclution is that digitalis has a solid place in the treatment of heart failure with sinus rhytm. The drug is cheap and safe if used properly on the right indications. Secondly the doses of today are too high. There are also a differnce in mortality among the sexes and that should be noted. Regardless of sex, you should not withdraw digitalis if you are on a stabil therapeutic regime including the drug.