ABC of heart failure: Management: digoxin and other inotropes, ß blockers, and antiarrhythmic and antithrombotic treatment
Use of digoxin for heart failure varies between countries across Europe, with high rates in Germany and low rates in the United Kingdom. It is potentially invaluable in patients with atrial fibrillation and coexistent heart failure, improving control of the ventricular rate and allowing more effective filling of the ventricle. Digoxin is also used in patients with chronic heart failure secondary to left ventricular systolic impairment, in sinus rhythm, who remain symptomatic despite optimal doses of diuretics and angiotensin converting enzyme inhibitors, where it acts as an inotrope.
Evidence of symptomatic benefit from digoxin in patients with chronic heart failure in sinus rhythm has been reported in several randomised placebo controlled trials and several smaller trials. The RADIANCE and PROVED trials, for example, reported that the withdrawal of digoxin from patients with congestive heart failure who had already been treated with the drug was associated with worsening heart failure and