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Digoxin in Heart Failure with Reduced Ejection Fraction: A Proposal for a Practical Precision Medicine-Based Guide

Introduction: the paradox of digitalis therapy

Digoxin holds a unique position in the history of cardiovascular medicine. Although it is the oldest drug in continuous use for heart failure (HF) treatment, there has been a sharp decline in prescriptions over the past two decades. Overshadowed by the advent of disease-modifying therapies and stigmatized due to concerns regarding toxicity, digoxin was relegated to a Class IIa recommendation in the Brazilian guideline and a third-line recommendation (Class IIb) in the major international guidelines.^,

Nonetheless, the systematic exclusion of digoxin may represent a historical error based on incomplete interpretations of old data. In a scenario where heart failure with reduced ejection fraction (HFrEF) still imposes high morbidity, mortality, and residual symptoms despite optimized therapy, the premise of this viewpoint is unequivocal: digoxin is not obsolete; what has become obsolete is the empirical fixed-dose prescription model. In light of contemporary evidence, we propose a revival of digitalis therapy guided by precision medicine.

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Digoxin: the results of the DIG study in the XXI century

Izo Helber et al. Paulo J. F. Tucci

After the report that there was no statistical significance in the general mortality of the DIG study, the indication of digoxin in the treatment regimens for congestive heart failure (CHF) drastically decreased. Post hoc studies that reassessed the DIG study data, indicated that an aspect that was not considered in this multicenter study has a critical influence on the prognosis of patients: the serum levels of digoxin. Regarding those that received a placebo, the general mortality and hospitalization were decreased in patients with a digoxin level < 0.9 ng/ml. At the first study that assessed the influence of digitalis in an experimental model of CHF, we verified in our lab that female rats with congestive syndrome secondary to myocardial infarction have a prolonged survival when undergoing treatment with digitoxin. The current information recommends that the merits of digoxin continue to be analyzed in order to adequately establish its importance in the treatment of CHF.

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Digoxin in Heart Failure with Reduced Ejection Fraction: A Proposal for a Practical Precision Medicine-Based Guide

Introduction: the paradox of digitalis therapy

Digoxin: the results of the DIG study in the XXI century

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)