Is there still a role for digoxin?
With the recent demonstration of survival benefits for beta blockade and spironolactone, there is less place for digoxin in the treatment of heart failure. This is because the only major trial of digoxin in patients with systolic heart failure and sinus rhythm did not find a survival benefit.4 Nevertheless, this study and others (primarily studies of withdrawal of digoxin) did show a beneficial effect of digoxin on patients symptoms, with an overall reduction in hospitalisation due to heart failure. Digoxin may therefore still have a limited role, purely for symptom relief, in patients with severe heart failure. Digoxin remains valuable therapy for patients in systolic heart failure with atrial fibrillation. It has an established role in controlling the ventricular response. Dilemma 5: What is the best alternative for patients who cannot tolerate ACE inhibitors? The commonest reason for intolerance of ACE inhibitors in patients with heart failure is cough. However, this problem seems l
