Withdrawal of Digoxin from Patients with Chronic Heart Failure Treated with Angiotensin-Converting-Enzyme Inhibitors

Abstract

These findings indicate that the withdrawal of digoxin carries considerable risks for patients with chronic heart failure and impaired systolic function who have remained clinically stable while receiving digoxin and angiotensin-converting-enzyme inhibitors.

Digitalis Toxicity: A Fading but Crucial Complication to Recognize

“…Digoxin continues to play a role in treatment of chronic systolic/diastolic heart failure and atrial fibrillation. However, due to several landmark studies showing physiologic and symptomatic improvement [2][3][4][5] but no demonstrable impact on overall survival in heart failure, 2 other agents shown to have significant morbidity and mortality benefits, including beta-blockers, angiotensin-converting enzyme-I inhibitors, and aldosterone antagonists, have been preferentially employed. Estimates of digoxin usage in heart failure in the past decade have decreased from approximately 80% to Ͻ30%, with only 8% of patients being started on digoxin with symptoms of heart failure before discharge.…”

ProBNP for stratifying patients with heart failure

“…When the patient selection was based on symptoms, the digitalis studies showed that the patients taking or not taking digitalis had a similar outcome [17][18][19] , the exception being those with a third heart sound, when digitalis suspension provokes clinical deterioration 17 . On the other hand, when patient selection was based on left ventricular systolic dysfunction (ejection fraction lower than 0.40), it was possible to verify that digitalis improves clinical symptoms and outcome and that suspension of digitalis induces a clinical deterioration in the majority of the patients [20][21][22] .…”

Insuficiência cardíaca

“…Quatro grandes estudos, DIMT, RADIANCE, PROVED E DIG fundamentaram o seu emprego clínico [22][23][24][25] . Hoje, sabemos que nos portadores de IC sintomáticos, o digital reduz a estimulação neuro-humoral, melhora o desempenho fí-sico, reduz hospitalizações e não aumenta sua mortalidade.…”

“…Dados dos estudos RA-DIANCE, PROVED e DIG mostraram que os pacientes nas formas mais avançadas são os mais beneficiados com a manutenção da terapêutica [23][24][25] e que nos pacientes com formas discretas da doença, a suspensão do digital provocou pequena repercussão ( fig. 6).…”