Effects of Digoxin in Heart Failure (HF) With Reduced Ejection Fraction (EF).

Riya R Parikh,Peter Magnusson,Joseph V Pergolizzi,Khushbu R Patel,Frank Breve

doi:10.7759/cureus.22778

Abstract

In this review, we evaluated the literature on the benefits and deleterious effects of digoxin in heart failure (HF) with reduced ejection fraction (EF). Although digoxin was considered an effective treatment for HF, the supporting evidence is conflicting. Before the conventional use of modern HF therapies, digoxin was widely used for symptomatic relief on these patients. Further randomized trials are required to reach a definite conclusion about its efficacy and safety in patients experiencing HF with a reduced EF (HFrEF).

Highlights

BackgroundDigoxin is a drug derived from the foxglove plant ( Digitalis) and is used to treat heart failure (HF) and rate control of atrial fibrillation (AF)
We evaluated the literature on the benefits and deleterious effects of digoxin in heart failure (HF) with reduced ejection fraction (EF)
We evaluated current literature from randomized studies to estimate the efficacy of digoxin in HF with a reduced EF (HFrEF) concerning hospitalization events and mortality

Summary

Introduction

Digoxin is a drug derived from the foxglove plant ( Digitalis) and is used to treat heart failure (HF) and rate control of atrial fibrillation (AF). Even though many HF patients are medically managed on evidence-based but complex drug therapy, there is still a high rate of morbidity, mortality, and hospital admissions and readmissions seen for HF patients. Since digoxin alters cardiac output and decreases pulmonary capillary wedge pressure without increasing the heart rate or reducing blood pressure, it has demonstrated a reduction in all-cause and cardiovascular (CV) hospitalizations as seen in the Digitalis Investigation Group (DIG) trial, but no effects on all-cause and CV mortality rates [11]. The 2021 ESC guidelines for diagnosis and treatment of acute and chronic HF suggest a potential benefit of using digoxin to obtain ventricular rate control in patients with HFrEF and AF who cannot utilize other therapies [15]. We evaluated current literature from randomized studies to estimate the efficacy of digoxin in HFrEF concerning hospitalization events and mortality

Methods

Conclusions

Findings

Disclosures