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Digitalis for treatment of congestive heart failure in patients in sinus rhythmHood, Jr. WB, Dans AL, Guyatt GH, Jaeschke R, McMurray JJV
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SummaryDigitalis for treatment of congestive heart failure in patients in sinus rhythmDigitalis is a drug that is extracted from the leaves of the foxglove plant. It contains substances that stimulate heart muscle. The drug has been used for over two centuries to treat heart failure, a condition caused by inability of injured hearts to pump blood adequately. Other drugs that may be useful include diuretics, angiotensin converting enzyme inhibitors, and beta-blockers, but digitalis may also be beneficial. The review of trials found that digitalis reduces hospitalization and can help to relieve symptoms of heart failure. More research is needed to show the full effects of digitalis.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 22. 2001 AbstractBackgroundDigitalis glycosides have been in clinical use in the treatment of congestive heart failure (CHF) for more than 200 years. In recent years several trials have been conducted to address concerns about efficacy and toxicity. Although a systematic review of the literature was published in 1990, an update is required to include more current trials. ObjectivesTo examine the effectiveness of digitalis glycosides in treating CHF in patients with normal sinus rhythm. To examine the effect of digitalis in patients taking diuretics, angiotensin converting enzyme inhibitors, and beta-blockers; patients with varying severity and duration of disease; patients with prior exposure to digitalis versus no prior exposure; and patients with "CHF due to systolic dysfunction" versus "CHF with preserved systolic function". Search strategyThe Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 4 2008, MEDLINE (1966 to November 2008), EMBASE (1990 to November 2008) and Dissertation Abstracts (to November 2008) were searched. Annual meeting abstracts of the American Heart Association, American College of Cardiology, and European Society of Cardiology were also searched from 1996 to November 2008. In addition, reference lists provided by the pharmaceutical industry (GlaxoSmithKline) were searched. Selection criteriaIncluded were randomized placebo-controlled trials of 20 or more adult patients of either sex with symptomatic CHF who were studied for seven weeks or more. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of CHF such as acute ischemic heart disease or myocarditis was present. Data collection and analysisArticles selected from the searches described above were evaluated as a joint effort of the coauthors. The staff of the Cochrane Heart Group ran searches on the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. Main resultsThirteen studies (7896 participants) meeting the defined criteria were identified, and major endpoints of mortality, hospitalization, and clinical status, based respectively upon 8, 4, and 12 of these selected studies, were recorded and analyzed. The data show that there is no evidence of a difference in mortality between treatment and control groups, whereas digitalis therapy is associated with a lower rate of hospitalization and of clinical deterioration. The largest study showed a significant rise in other cardiac deaths, possibly due to arrhythmias. However collectively these findings were based on studies done before beta-blockers became widely used to treat CHF. Authors' conclusionsThe literature indicates that digitalis may have a useful role in the treatment of patients with CHF who are in normal sinus rhythm. New trials are needed to elucidate the importance of digitalis dosage, and its usefulness in the era of beta-blockers. |