Contemporary use of digoxin in clinical practice

Contact address: Carmen Ginghină, “CC Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania Fundeni Street, no. 258, sector 2, 022328, Bucharest, Romania. Email: carmenginghina2010@gmail.com 1 “Prof. Dr. C. C. Iliescu” Emergency Institute of Cardiovascular Diseases, Bucharest, Romania 2 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Abstract & aims: Although mortality is the most important clinical endpoint in heart failure (HF) clinical trials, it is now recognized that preventing HF hospitalization is important for patients and healthcare systems. In the Digitalis Investigation Group (DIG) trial, digoxin reduced hospitalization due to heart failure (HF) and improved outcomes in high-risk subgroups of HF patients. In our study, we investigated the contemporary use of digoxin in clinical practice based on current knowledge. Methods and results – We retrospectively studied the medical fi les of 300 patients (58% men, 65±12 years) admitted for both systolic and diastolic HF of different etiologies, in NYHA functional class II-IV. Having in mind the original design of the DIG trial and the recommendations of the current guidelines, we focused on the subgroup of patients with heart failure and reduced left ventricular ejection fraction (LVEF) (REF-HF) (LVEF less than 45%) in sinus rhythm. Only 26 patients (31.7% of patients in this subgroup) received digoxin. On the other hand, in the subgroup of patients with atrial fi brillation 89 patients (60.13% of patients in this subgroup) were treated with digoxin. A higher heart rate at admission and a lower LVEF were predictors of digoxin choice in atrila fi brillation subgroup. Comparing patients treated with digoxin to non-digoxin patients, we concluded that the more severe the HF (in terms of clinical, biological and echocardiographic parameters), the more likely will be for the patient to receive digoxin. Markers of severity were advanced functional NYHA class, clinical signs of elevated LV fi lling pressures, tachycardia, lower sodium levels and depressed LV function as assessed by LVEF. Conclusion – This study highlighted the fact that in current clinical practice digoxin is a therapy of last resort and this drug is chosen in patients with more advanced HF.