With interest we read the study by Ahmed et al [ [1] Ahmed A. Pitt B. Rahimtoola S. et al. Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: a propensity-matched study of the DIG-trial. Int J Cardiol. 2008; 123: 138-146 Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar ] in which the authors showed that morbidity and mortality in patients with chronic heart failure (CHF) was significantly reduced by digoxin at low serum digoxin concentrations (SDC) in the DIG study, and that these low SDCs were strongly related to low-dose use of the drug. Clearly, digoxin still has an important place in the management of patients with CHF [ [2] Gheorghiade M. Van Veldhuisen D.J. Colucci W. Contemporary use of digoxin in the management of cardiovascular disorders. Circulation. 2006; 113: 2556-2564 Crossref PubMed Scopus (164) Google Scholar ] as the authors point out, but its role has been declining in recent years. In a large CHF trial that was conducted between 1992 and 1995 (PRIME-II) [ [3] Hampton J.R. Van Veldhuisen D.J. Kleber F.X. et al. Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure. Lancet. 1997; 349: 971-977 Abstract Full Text Full Text PDF PubMed Scopus (323) Google Scholar ], as many as 64% of the population was using digoxin at the time, although there were large differences between European countries, with digoxin use ranging from 39% in the UK to 87% in Germany [ [4] Van Veldhuisen D.J. Charlesworth A. Crijns H.J.G.M. Lie K.I. Hampton J.R. Differences in drug treatment of chronic heart failure between European countries. Eur Heart J. 1999; 20: 666-672 Crossref PubMed Scopus (54) Google Scholar ]. In a recent large CHF survival study (CORONA), which enrolled patients between 2003 and 2005, only 33% was still using digoxin [ [5] Kjekshus J. Apetrei E. Barrios V. et al. Rosuvastatin in older patients with heart failure. N Engl J Med. 2007; 357: 2248-2261 Crossref PubMed Scopus (1244) Google Scholar ]. Although the populations were largely comparable in terms of baseline demographics, there was a significant difference in age (mean age in PRIME-II vs CORONA, 65±9 years vs 73±9 years). Furthermore, in contrast to the decrease in digoxin use was the increase in the use of beta-blockers, going from only 6% in 1992–1995 [ 3 Hampton J.R. Van Veldhuisen D.J. Kleber F.X. et al. Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure. Lancet. 1997; 349: 971-977 Abstract Full Text Full Text PDF PubMed Scopus (323) Google Scholar , 4 Van Veldhuisen D.J. Charlesworth A. Crijns H.J.G.M. Lie K.I. Hampton J.R. Differences in drug treatment of chronic heart failure between European countries. Eur Heart J. 1999; 20: 666-672 Crossref PubMed Scopus (54) Google Scholar ] to 75% in 2003–2005 [ [5] Kjekshus J. Apetrei E. Barrios V. et al. Rosuvastatin in older patients with heart failure. N Engl J Med. 2007; 357: 2248-2261 Crossref PubMed Scopus (1244) Google Scholar ].