Digitalis for treatment of congestive heart failure in patients in sinus rhythm

Hood, W.B., Dans, A., Guyatt, G.H., Jaeschke, R. and McMurray, J.J.V. (2009) Digitalis for treatment of congestive heart failure in patients in sinus rhythm. Cochrane Database of Systematic Reviews(2), CD002901. (doi: 10.1002/14651858.CD002901.pub2)

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Background: Digitalis 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. Objectives: To 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 strategy: The 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 criteria: Included 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 analysis: Articles 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 results: Thirteen 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' conclusions: The 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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Hood, W.B., Dans, A., Guyatt, G.H., Jaeschke, R., and McMurray, J.J.V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences
Journal Name:Cochrane Database of Systematic Reviews

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