Effects Of Digitalis Research Articles

Digitalis for treatment of congestive heart failure in patients in sinus rhythm.

Digitalis glycosides have been in clinical use in the treatment of congestive heart failure (CHF) for more than 200 years. In recent years several trials have been conducted to address concerns about efficacy and toxicity. Although a systematic review of the literature was published in 1990, an update is required to include more current trials. To examine the effectiveness of digitalis glycosides in treating CHF in patients with normal sinus rhythm. To examine the effect of digitalis in patients taking diuretics, angiotensin converting enzyme inhibitors, and beta-blockers; patients with varying severity and duration of disease; patients with prior exposure to digitalis vs. no prior exposure; and patients with "CHF due to systolic dysfunction" vs. "CHF with preserved systolic function." The Cochrane Central Register of Controlled Trials (CENTRAL) 2003 Issue 4, MEDLINE (1966 to December 2003) and EMBASE (1990 to December 2003) were searched. Dissertation Abstracts and annual meeting abstracts of the American Heart Association, American College of Cardiology, and European Society of Cardiology were also searched from 1996-2003. In addition, reference lists provided by the pharmaceutical industry (Glaxo Wellcome Inc.) were searched. Included were randomized placebo-controlled trials of 20 or more adult patients of either sex with symptomatic CHF who were studied for seven weeks or more. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of CHF such as acute ischemic heart disease or myocarditis was present. Articles selected from the searches described above were evaluated as a joint effort of the coauthors. The staff of the Cochrane Heart Group ran searches on the Cochrane Central Register of Controlled Trials. Thirteen articles meeting the defined criteria were identified, and major endpoints of mortality, hospitalization, and clinical status, based respectively upon 8, 4, and 12 of these selected studies, were recorded and analyzed. The data show that there is no evidence of a difference in mortality between treatment and control groups, whereas digitalis therapy is associated with a lower rate of hospitalization and of clinical deterioration. The literature indicates that digitalis has a useful role in the treatment of patients with CHF who are in normal sinus rhythm.

P-040 the effects of digitalis and betablocker on dual av nodal pathways and conduction during induced atrial fibrillation

P-040 the effects of digitalis and betablocker on dual av nodal pathways and conduction during induced atrial fibrillation

P-040 The effects of digitalis and betablocker on dual AV nodal pathways and conduction during induced atrial fibrillation

P-040 The effects of digitalis and betablocker on dual AV nodal pathways and conduction during induced atrial fibrillation

The role of the pharmacy coordinating center in the DIG trial

Large simple trials (LSTs) emerged in response to the need for large sample sizes to answer important clinical questions in which treatments have a moderate effect on clinical endpoints. Between 1991 and 1996 the National Heart, Lung, and Blood Institute and the Department of Veterans Affairs (VA) Cooperative Studies Program conducted an LST entitled “Digitalis Investigation Group (DIG): Trial to Evaluate the Effect of Digitalis on Mortality in Heart Failure.” The VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center served as the DIG pharmacy coordinating center (PCC). As a direct result of involvement in the DIG trial, the PCC identified the need for an increased emphasis on computerization and automated support of clinical trials, especially LSTs.

Effects of dopamine, prostaglandins and digitalis on isolated abdominal vagus nerve in rats

From Volume 20 (2006), this title is published by Society of Integrated Sciences (International Medart, PO Box 37, 814 99 Bratislava 1, Slovak Republic, E-mail: publisher@nel.edu, Fax: +41 13553207).

What is wrong with positive inotropic drugs? Lessons from basic science and clinical trials

Chronic mechanical overload modifies myocardial performance to adapt muscle economy to new environmental conditions. Improved thermodynamic status is achieved by reexpression of the foetal programme, which slows the maximum shortening velocity and impairs the adrenergic system. This is followed by the most characteristic structural change in chronic mechanical overload - the development of a permanent negative inotropic state. Consequently, the prescription of inotropic drugs in chronic heart failure (CHF) goes against the physiological processes of adaptation. The situation in clinical practice is confused by the fact that several inotropic drugs have additional vasodilatory effects. However, large clinical trials have shown that, except for digitalis, inotropes have an overall deleterious effect on long-term survival in CHF. The Digitalis Investigation Group (DIG) trial concluded that digoxin has no influence on all-cause or cardiovascular mortality, but that it reduces risk of hospitalization for CHF. It is proposed that the beneficial effects of digitalis are due to its sympatholytic effects. Given that several other classes of drugs have clearly been shown to reduce mortality, there is decreasing support for long-term use of digoxin in CHF. This class of drugs should now be considered most suitable for short-term use in acute episodes of decompensated heart failure.

Progesterone attenuates the inhibitory effects of cardiotonic digitalis on pregnenolone production in rat luteal cells.

Previous studies have shown that digoxin decreases testosterone secretion in testicular interstitial cells. However, the effect of digoxin on progesterone secretion in luteal cells is unclear. Progesterone is known as an endogenous digoxin-like hormone (EDLH). This study investigates how digitalis affected progesterone production and whether progesterone antagonized the effects of digitalis. Digoxin or digitoxin, but not ouabain, decreased the basal and human chorionic gonadotropin (hCG)-stimulated progesterone secretion as well as the activity of cytochrome P450 side chain cleavage enzyme (P450scc) in luteal cells. 8-Br-cAMP and forskolin did not affect the reduction. Neither the amount of P450scc, the amount of steroidogenic acute regulatory (StAR) protein, nor the activity of 3beta-hydroxysteroid dehydrogenase (3beta-HSD) was affected by digoxin or digitoxin. Moreover, in testicular interstitial and luteal cells, progesterone partially attenuated the reduction of pregnenolone by digoxin or digitoxin and the progesterone antagonist, RU486, blocked this attenuation. These new findings indicated that (1) digoxin or digitoxin inhibited pregnenolone production by decreasing the activity of P450scc enzyme, but not Na(+)-K(+)-ATPase, resulting in a decrease on progesterone secretion in rat luteal cells, and (2) the inhibitory effect on pregnenolone production by digoxin or digitoxin was reversed partially by progesterone. In conclusion, digoxin or digitoxin decreased progesterone production via the inhibition of pregnenolone by decreasing P450scc activity. Progesterone, an EDLH, could antagonize the effects of digoxin or digitoxin in luteal cells.

INHIBITORY EFFECTS OF DIGITALIS ON THE PROLIFERATION OF ANDROGEN DEPENDENT AND INDEPENDENT PROSTATE CANCER CELLS

Digitalis or cardiac glycosides have been noted to induce tumor static or oncolytic effects in various types of cancer. We evaluated the effects and underlying mechanisms of cardiac glycosides, including digoxin, digitoxin and ouabain, on the proliferation of hormone dependent and independent prostate cancer cell lines. Cell proliferation of the 3 human prostate cancer cell lines LNCaP, DU145 and PC3 was measured by 3-(4,5-dimethylthiazol-2-yle)2,5-diphenyltetralozium bromide (Sigma Chemical Co., St. Louis, Missouri) colorimetric assay. The cytotoxic effects of digitalis on prostate cancer cells were determined by lactate dehydrogenase measurements of the culture medium. Intracellular Ca2+ was measured by a dual wavelength spectrometer system. The percent of apoptotic cells after digitalis treatment was measured by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling and flow cytometry. Digoxin, digitoxin and ouabain significantly inhibited the proliferation of LNCaP, DU145 and PC3 cells at a dose of 1 or 10 microM. after 1 to 4 days of culture. Cytotoxicity of digitalis on the DU145 and LNCaP cells was dose dependent but cytotoxicity was not obvious in PC3. Digitalis (1 microM.) significantly increased intracellular Ca2+ in LNCaP and DU145 after 12 hours of culture but PC3 cells needed a 24-hour treatment to show any effect. In the apoptosis measurement digitalis at a dose of 1 and 10 microM. also significantly increased the percent of apoptotic cells in the LNCaP, DU145 and PC3 cell lines. Normal control human glomerular epithelial cells showed no response to digitalis treatment at all tested doses. Digitalis may inhibit the proliferation of prostate cancer cell lines, although the 3 cell lines showed varied sensitivity to digitalis. These effects are possibly the result of a mechanism involving sustained elevation of the concentration of intracellular Ca2+ and of apoptosis.

Digitalis for treatment of congestive heart failure in patients in sinus rhythm.

Digitalis glycosides have been in clinical use in the treatment of congestive heart failure for more than 200 years. In recent years several trials have been conducted to address concerns about efficacy and toxicity. Although a systematic review of the literature was recently published, an update is required to include more current trials. To examine the effectiveness of digitalis glycosides in treating congestive heart failure in patients with normal sinus rhythm. To examine the effect of digitalis in patients taking diuretics, angiotensin converting enzyme (ACE) inhibitors, and beta blockers; patients with varying severity and duration of disease; patients with prior exposure to digitalis vs. no prior exposure; and patients with diastolic vs. systolic dysfunction. Electronic databases were searched between 1966 and 2000. Dissertation Abstracts and annual meeting abstracts of the American Heart Association, American College of Cardiology, and European Society of Cardiology were searched from 1996-2000. In addition, reference lists provided by the pharmaceutical industry (Glaxo Wellcome Inc.) were searched. Included were randomized placebo-controlled trials of 20 or more adult patients of either sex with symptomatic congestive heart failure who were studied for seven weeks or more. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of heart failure such as acute ischemic heart disease or myocarditis was present. Articles selected from the searches described above were reviewed by one of the coauthors, and validated by staff from the central office of the Heart Collaborative Review Group in Bristol, UK. Eleven articles meeting the defined criteria were identified, and major endpoints of mortality, hospitalization, and clinical status, based respectively upon 8, 4, and 10 of these selected studies, were recorded and analyzed. The data show that there is no difference in mortality between treatment and control groups, whereas digitalis therapy is associated with a lower rate of hospitalization and of clinical deterioration. The literature indicates that digitalis has a useful role in the treatment of patients with congestive heart failure who are in normal sinus rhythm.

Direct inhibitory effect of digitalis on progesterone release from rat granulosa cells.

Digoxin (10(-7) - 10(-5) M) or digitoxin (10(-7) - 10(-5) M) decreased the basal and human chorionic gonadotropin (hCG)-stimulated release of progesterone from rat granulosa cells. Digoxin (10(-5) M) or digitoxin (10(-5) M) attenuated the stimulatory effects of forskolin and 8-bromo-cyclic 3' : 5'-adenosine monophosphate (8-Br-cAMP) on progesterone release from rat granulosa cells. Digoxin (10(-5) M) or digitoxin (10(-5) M) inhibited cytochrome P450 side chain cleavage enzyme (cytochrome P450(scc)) activity (conversion of 25-hydroxyl cholesterol to pregnenolone) in rat granulosa cells but did not influence the activity of 3beta-hydroxysteroid dehydrogenase (3beta-HSD). Neither progesterone production nor P450scc activity in rat granulosa cells was altered by the administration of ouabain. Digoxin (10(-5) M) or digitoxin (10(-5) M), but not ouabain, decreased the expression of P450scc and steroidogenic acute regulatory (StAR) protein in rat granulosa cells. The present results suggest that digoxin and digitoxin decrease the progesterone release by granulosa cells via a Na(+),K(+)-ATPase-independent mechanism involving the inhibition of post-cyclic AMP pathway, cytochrome P450scc and StAR protein functions.

Recurrent Mitral Stenosis: Problems of Management

Abbreviation: TEE 5 transesophageal echocardiography A 44-year-old woman was evaluated for the primary complaint of the sensation of rapid and irregular beating of the heart, which was intensified by exertion. This sensation had been apparent for approximately 2 months and was associated with increased fatigability. Her previous history disclosed that elsewhere, 21 years previously, she had undergone aortic valve replacement combined with mitral valvotomy, but the records of this event were unavailable. She had never previously noted a rapid or irregular heart rhythm, and the remainder of the history and review of systems was completely negative. Three weeks previously, her referring physician had initiated regular oral treatment with digoxin and warfarin. On examination, the BP was 130/80 mm Hg, and the pulse rate was estimated at 85 beats/min and irregular. Physical findings included a displaced apical impulse to 1 cm lateral to the midclavicular line. An accentuated first heart sound and a soft mitral opening snap were audible. Opening and closing sounds were compatible with a mechanical aortic prosthetic valve. There was a grade 2/6 apical pansystolic murmur together with a grade 2/6 mid diastolic rumbling murmur consistent with combined mitral stenosis and regurgitation. A grade 3/6 early systolic ejection murmur was noted at the base together with a soft, high-pitched (blowing) diastolic decrescendo murmur (grade 1/6) heard maximally at the mid-left sternal border and consistent with aortic regurgitation. The lungs were clear to auscultation, and the findings of the remainder of the examination were normal. The ECG disclosed atrial fibrillation with a ventricular response rate of 75 beats/min; ST-T abnormalities were consistent with the effect of digitalis. An echocardiogram disclosed an enlarged left atrium (diameter, 4.8 cm). The mitral valve was thickened and stenotic, with a valve area estimated by both direct planimetric measurement and Doppler echocardiographic assessment to be approximately 1.1 cm 2 . Mild-to-moderate mitral regurgitation was demonstrated. A mechanical prosthetic valve in the aortic position was visualized, and peak systolic gradient of 47 mm Hg across this structure was derived by Doppler echocardiographic assessment. Mild regurgitation was noted across this orifice. The left ventricular size and systolic motion were normal. There was mild-to-moderate tricuspid regurgitation, from which the right ventricular systolic pressure was estimated to be in the range of 30 to 40 mm Hg. Chest radiography disclosed a cardiac silhouette indicative of left atrial enlargement, but the lung fields were clear. A mechanical prosthetic aortic valve was present together with evidence of a previous sternotomy.

The Effect of Digitalis or a Beta-Blocker, Alone or in Combination, on Atrial Fibrillation at Rest and During Exercise

Carbonic anhydrase (CA) isozymes CAII and CAIII were assayed by a radioimmunosorbent technique in liver cytosolic fractions and in isolated hepatocytes of adult male and female rats. Male livers contained 0.16 mg of CAII and 57 mg of CAIII per g cytosolic protein. Corresponding values for female livers were 0.34 mg CAII and 4 mg CAIII. Similar values and differences between CAII and III were found in isolated hepatocytes. Neonatal and adult castration of males reduced the CAIII levels to those of the females. Treatment with testosterone for three weeks restored the copulatory behaviour in the males castrated at adult age, but restored only partially the levels of CAIII. No significant effects of the endocrine manipulations were seen on CAII.Oophorectomy, with or without testosterone substitution, had no significant effect on CAII and CAIII levels in female rats.Immunohistochemistry and histochemistry showed that the regulation of CAIII is confined to perivenous hepatocytes. CAIII can therefore serve as a useful marker in the separation of these cells.CAIII appears to belong to the proteins and enzymes of the rat liver, known to be regulated via the hypothalamo-pituitary-liver axis. It may be used as a model of gene regulation in perivenous hepatocytes.

Pharmacodynamic principles of homeopathy

Homeopathy was already known to Hippocrates and further studied by Hahnemann. However, since the discovery of the medical effects of digitalis by William Withering around 1785, and the first synthesis of an organic molecule, urea, by Friedrich Wöhler in 1828, and through the further rapid evolution of modern pharmacological chemistry and molecular biology, it has gradually been abandoned as a serious therapeutic alternative to allopathy by most practitioners of scientifically founded medicine. Because a credible scientific explanation for its mode of action has been lacking, homeopathy is regarded by many medical researchers and scientists as, at best, placebo therapy, in spite of the fact that for centuries hosts of patients have testified to its effects. It is suggested that the gulf between homeopathy and allopathy can be reconciled if one takes into consideration modern knowledge of physiology, biochemistry and the physical properties of the water used in the potentiation process. A description of the mechanisms occurring during potentiation, both inside and outside a live mammalian organism, is presented.

Further evidence suggesting a limited role of digitalis in infants with circulatory congestion secondary to large ventricular septal defect

In infants with a large ventricular septal defect, the acute hemodynamic effect of intravenous digitalis varies depending on baseline systemic and pulmonary resistance. Digitalis may act adversely by increasing pulmonary blood flow with an elevation in left atrial pressure in severely congested infants with ventricular septal defects.

Safety of oral propafenone in the conversion of recent onset atrial fibrillation to sinus rhythm:: A prospective parallel placebo-controlled multicentre study

Aim: Oral propafenone is effective in restoring sinus rhythm however the proarrhythmic effects are still unknown. The Safety Antiarrhythmic Therapy Evaluation (SATE) trial was a prospective randomized placebo-controlled multicentre study which evaluated the safety of acute oral loading dose of propafenone in patients with recent onset atrial fibrillation. Secondary end-points were to evaluate the effect of digitalis added to propafenone in ventricular rate control and the efficacy of propafenone alone or added to digitalis compared with efficacy of digitalis plus quinidine. Methods and results: 246 patients (126 male; 58±11 years) with atrial fibrillation of <48 h duration were randomly allocated to one of four groups: digitalis 0.75–1 mg i.v. plus quinidine 1100 mg (D+Q, 70 patients); propafenone 450–600 mg orally (PNF, 66 patients); propafenone 450–600 mg orally plus digitalis 0.750–1 mg i.v. (PNF+D, 70 patients); placebo (Pl, 40 patients). All patients underwent 24-h ECG Holter monitoring. Safety was assessed by evaluating the appearance of adverse events classified as mild, moderate and severe. No severe adverse events were reported. Short lasting asymptomatic atrial flutter episodes with atrio–ventricular conduction ≥2:1 were observed in 14% of the D+Q group, 21% PNF, 18% PNF+D and in 8% Pl. One patient in the D+Q group and four in the PNF+D group showed asymptomatic runs of 3–4 ventricular ectopic beats. Reversible sinus atrial blocks (<3 s) were detected in two patients of the D+Q group and in two of the PNF group. In patients with persistent atrial fibrillation the ventricular rate was similar in the four study groups. At 3 h the high efficacy of propafenone was confirmed. At the 24th hour no differences were found between active treatment and placebo arms. Conclusion: Propafenone in a single oral loading dose is safe and promptly effective in patients with recent onset atrial fibrillation.

Digitalis increases brain natriuretic peptide in patients with severe congestive heart failure

Ouabain can cause increased secretion of atrial natriuretic peptide (ANP) from atrial cardiocyte culture, but the effects of digitalis in a therapeutic range on the secretion of cardiac natriuretic peptide including ANP and brain natriuretic peptide (BNP), mainly from the ventricle, in patients with congestive heart failure remain to be investigated. Therefore we studied the acute effects of intravenous infusion of a relatively low dose of digitalis or placebo on hemodynamics and neurohumoral factors including the plasma levels of ANP and BNP and cyclic guanosine monophosphate, a second messenger of cardiac natriuretic peptide, in 13 patients with severe congestive heart failure. No significant change in the hemodynamic parameters or neurohumoral factors was observed with placebo. After 1 hour of intravenous administration of deslanoside (0.01 mg/kg), there was a significant decrease of plasma renin activity and angiotensin II, aldosterone, and norepinephrine levels but no significant change of plasma levels of vasopressin and a significant decrease of the pulmonary capillary wedge pressure but no significant change in cardiac index. In addition, plasma levels of ANP (217 +/- 47 vs 281 +/- 70 pg/ml, p < 0.05), BNP (628 +/- 116 vs 689 +/- 132 pg/ml, p < 0.05), and cyclic guanosine monophosphate (9.7 +/- 1.1 vs 10.9 +/- 1.5 pmol/ml, p < 0.05) increased despite the decrease of pulmonary capillary wedge pressure (19.7 +/- 2.3 vs 16.8 +/- 2.3 mm Hg, p < 0.05). These results indicate the acute intravenous low dose of digitalis resulted in a significant increase in plasma levels of ANP, BNP, and cyclic guanosine monophosphate concomitant with the significant decrease of pulmonary capillary wedge pressure, suggesting the acute direct action of digitalis on the cardiac natriuretic peptides released from the heart in patients with severe congestive heart failure.

Acute effects of digitalis and enalapril on the neurohormonal profile of chagasic patients with severe congestive heart failure

Chagasic patients with congestive heart failure are usually treated with digitalis and converting enzyme inhibitors. According to the neurogenic and dysautonomic theories, chagasic patients would not benefit from these drugs. To clarify this controversial issue, we have studied patients with congestive heart failure and suspected Chagas' heart disease. All patients received intravenous methyl-digoxin for 24 h and oral enalapril for 96 h. Blood samples for plasma norepinephrine, aldosterone and renin were taken at baseline, after acute digitalization and following enalapril. Based on the serology for Chagas' disease, the patients were divided into non-chagasic and chagasic patients. In the chagasic group three patients were in functional class III and 3 were in functional class IV. In the non-chagasic group five patients were in functional class III and 2 were in functional class IV. Both groups had a marked and quantitatively similar degree of neurohormonal activation. All patients improved at least one functional class and lost more than 5 kg of body weight with treatment. The chagasic patients had a statistically significant reduction in plasma norepinephrine (2262 ± 1407 to 865 ± 390, P < 0.008, pg/ml, M ± S.D.), plasma aldosterone (330 ± 168 to 155 ± 75, P < 0.01, pg/ml, M ± S.D.) and plasma renin activity (14 ± 13 to 2 ± 1.6 ng/ml per h, M ± S.D., P < 0.05), with digitalis. Following enalapril, norepinephrine and aldosterone there was a further but non-significant reduction, when compared to postdigitalis values. These results indicated that chagasic patients do benefit from digitalis and enalapril. Furthermore, the prominent and significant reduction in all three neurohormones suggest that the parasympathetic and sympathetic systems of these chagasic and non-chagasic patients, are responding to the neuromodulatory effects of digitalis and enalapril.

Effect of digitalis on conduction dysfunction in Pelizaeus-Merzbacher disease

We studied the effect of digitalis on nerve conduction dysfunction in Pelizaeus-Merzbacher disease (PMD). The patients were three Japanese boys with PMD, aged 7–10 years. Digitalis was administered orally in a daily dose of 0.06 mg/kg for 2 consecutive months, and the obtained serum concentrations ranged from 0.33 to 0.55 ng/ml. The digitalis therapy induced slight improvement of severe dysarthria and cognitive dysfunction in the two older patients. Electrophysiological examinations revealed the following results: In brainstem auditory evoked potentials (BAEPs), while waves II (or III) to V were absent before treatment, on treatment all waves of BAEPs except a wave IV were restored in all patients. While visual evoked potentials (VEPs) in response to transient flash stimulation showed markedly prolonged latencies before treatment, digitalis produced a mild, although not statistically significant, shortening of the latency of N160. There were also no significant changes in inter-peak amplitudes of VEPs. Transcranial cortical magnetic stimulation continued to fail to elicit motor evoked potentials of the first dorsal interosseous muscles in all patients. Thus, although the serum concentrations were insufficient to elicit favorable therapeutic effects, digitalis therapy provided slight relief of clinical symptoms with evidence of improvement of conduction dysfunction. It is suggested that patients with PMD may respond to symptomatic treatment modulating nerve conduction.

Aging and cardiovascular disease: a summary of the Eighth Münster International Arteriosclerosis Symposium.

This unique symposium focused on the remarkable increase in the older population that is occurring in many countries of the world. The international experts spoke on the effects of aging on cardiovascular disease, which is by far the most prominent cause of morbidity and mortality in the elderly. The program highlighted some of the most prominent changes that occur in the elderly and influence the toll that cardiovascular disease takes. The program was divided into four sessions: (1) the effects of aging on some of the cardiovascular risk factors; (2) the effects of aging on the heart muscle; (3) reports on recent studies of the effects of aging on morphology and function of the conduction system; and (4) a session featuring outstanding authorities on aging and the elastin, collagen, and calcium of the vessel wall, all of which are frequently added to the artery wall during aging. The speakers were carefully selected from top scholars in England, Germany, Finland, France, Italy, Japan, and the United States. Professor W.H. Hauss, who pioneered the development of the Institute for Arteriosclerosis Research at the University of Munster, Germany, and is now in his 80s, opened the symposium and introduced four prominent officials in health, education, and other German government posts, who added their words of welcome. The first session was chaired by Professor G. Assmann, who is the current director of the Arteriosclerosis Research Institute in Munster, Germany. He gave the opening presentation on genetic determinants of life expectancy, a subject on which he is a world authority. He began his presentation with a brief description of the very large PROCAM study of more than 35 000 individuals, two thirds of whom are male, being carried out at the University of Munster Arteriosclerosis Institute in Westphalia. This long-term study of the natural history …

Digoxin worthy of addition to ACEIs and diuretics in CHF

The long-awaited results of the Effect of Digitalis on Mortality and Hospitalisations in Patients with Heart Failure study conducted by the Digitalis Investigation Group (DIG), show that digoxin had no impact on mortality in patients with congestive heart failure (CHF), most of whom were already taking angiotensin converting enzyme (ACE) inhibitors and diuretics. However, the drug exhibited overall clinical efficacy in virtually all subgroups of patients studied, according to investigators speaking at the 45th Annual Scientific Session of the American College of Cardiology [Florida, US; March 1996].