The use of digoxin in patients with worsening chronic heart failure: Reconsidering an old drug to reduce hospital admissions

Andrew P. Ambrosy, Javed Butler, Ali Ahmed, Muthiah Vaduganathan, Dirk J. Van Veldhuisen, Wilson S. Colucci, Mihai Gheorghiade*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

72 Scopus citations


Digoxin is the oldest cardiac drug still in contemporary use, yet its role in the management of patients with heart failure (HF) remains controversial. A purified cardiac glycoside derived from the foxglove plant, digoxin increases ejection fraction, augments cardiac output, and reduces pulmonary capillary wedge pressure without causing deleterious increases in heart rate or decreases in blood pressure. Moreover, it is also a neurohormonal modulator at low doses. In the pivotal DIG (Digitalis Investigation Group) trial, digoxin therapy was shown to reduce all-cause and HF-specific hospitalizations but had no effect on survival. With the discovery of neurohormonal blockers capable of reducing mortality in HF with reduced ejection fraction, the results of the DIG trial were viewed as neutral, and the use of digoxin declined precipitously. Although modern drug and device-based therapies have dramatically improved the survival of ambulatory patients with HF, outcomes for patients with worsening chronic HF, defined as deteriorating signs and symptoms on standard therapy often leading to unscheduled clinic or emergency department visits or hospitalization, have largely remained unchanged over the past 2 decades. The available data suggest that a therapeutic trial of digoxin may be appropriate in patients with worsening chronic heart failure who remain symptomatic.

Original languageEnglish (US)
Pages (from-to)1823-1832
Number of pages10
JournalJournal of the American College of Cardiology
Issue number18
StatePublished - May 13 2014


  • digoxin
  • heart failure
  • hospitalized
  • morbidity
  • mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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