title: Digoxin: The good and the bad.
abstract: After 230 years of use, digitalis remains an important and useful therapy for patients with atrial fibrillation, heart failure, and the 30-50 % of patients with both conditions. Although the combination of positive inotropic activity with negative chronotropic effects has been shown to reduce hospital admissions in heart failure, there is a distinct lack of robust trial data, particularly in patients with atrial fibrillation. We recently performed a comprehensive meta-analysis of all digoxin studies and demonstrated a neutral effect on mortality. This contradicts prior observational data that overlook the fact that digitalis is usually given as second-line therapy to the sickest patients. Use of these agents in clinical practice should take account of appropriate dose, serum concentration, drug interactions, and potential side effects. The aim of this review is to evaluate the evidence base for cardiac glycosides and provide a pragmatic guide to their advantages and disadvantages.
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Institute of Cardiovascular Science, University College London, London, UK.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Ziff
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Monash Centre of Cardiovascular Research & Education in Therapeutics, Monash University, Melbourne, Australia. Electronic address: d.kotecha@bham.ac.uk.
authors.forename: Dipak
authors.initials: D
authors.lastname: Kotecha
mesh_terms: D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004077:Digoxin / Q000009:adverse effects / Q000627:therapeutic use*; D006329:Heart Conduction System / Q000187:drug effects* / Q000503:physiopathology; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006352:Heart Ventricles / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D009200:Myocardial Contraction / Q000187:drug effects*; D010343:Patient Admission; D018579:Patient Selection; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D004077:Digoxin
keywords: Atrial fibrillation; Cardiac glycoside; Digoxin; Heart failure; Hospitalization; Mortality; Outcomes.