Whither withering? The role of digoxin in patients with heart failure due to systolic left ventricular dysfunction in sinus rhythm.

摘要

The Digoxin Investigators Group (DIG) trial demonstrated that the use of digoxin in patients with heart failure (HF) from systolic left ventricular dysfunction (SLVD) as well as in those with HF and preserved systolic left ventricular function (PSVF) had no significant benefit on survival but reduced hospitalization for HF. This has led to a significant decrease in its use over the past several years, and greater emphasis over the past several years, at least in patients with HF from SLVD, has been placed on optimization of the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers (BB), and, in patients with severe HF, aldosterone receptor blockers (ABs). There has also been increasing evidence for the use of cardiac resynchronization therapy (CRT) in patients with SLVD and left ventricular dyssynchrony both from a significant reduction in cardiovascular mortality and hospitalizations for HF, as well as the use of implantablecardiac defibrillators (ICDs), which have been shown to reduce mortality in patients with SLVD.