[The digitalis: should we forget it?].
For more than 200 years digitalis has been considered of paramount importance in the treatment of heart failure and atrial fibrillation. The IN-CHF Italian registry shows that prescriptions were reduced from 63.3% in the period 1995-1999 to 40% in the period 2000-2005, a very different trend compared to prescriptions of angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, and beta-blockers. The commercial value of digitalis is much lower than other drugs and it does not seem to be of interest for the pharmaceutical companies. Unfortunately, this is a logical trend in the business world. For many years the major indications of digitalis have been heart failure and atrial fibrillation. The most important study on efficacy of digitalis in the treatment of heart failure was the DIG trial (1997), which showed no difference in mortality when compared to placebo but significant beneficial effects in reducing hospital admission rates. Many post-hoc researches evaluated blood levels of digitalis and proved beneficial effects also on mortality when digoxinemia values were 0.5-0.9 ng/ml. In conclusion, digitalis should still be considered effective for the treatment of heart failure; therefore prescription modality as well as the range of normal values of digoxinemia should be updated.
Greco
Salvatore
S
Dipartimento di Malattie Cardiache, Ospedale San Filippo Neri, Roma. salvatore.greco@gmail.com
Antonini
Lanfranco
L
Auriti
Antonio
A
Leone
Francesca
F
Santini
Massimo
M
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004071:Digitalis Glycosides / Q000191:economics / Q000627:therapeutic use*; D004077:Digoxin / Q000097:blood / Q000627:therapeutic use; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D004071:Digitalis Glycosides; D004077:Digoxin