Update on digoxin and other oral positive inotropic agents for chronic heart failure

The benefit of digoxin in chronic heart failure has been debated fervently for decades. In the 1970s, the use of digoxin was challenged due to the high incidence of digitalis toxicity and the lack of data on the effects of digoxin in patients with chronic heart failure. In the 1980s, interest in digoxin was renewed after several trials with oral inotropic agents demonstrated increased mortality. Recently, several trials have studied the hemodynamic, neurohormonal, and clinical effects of digoxin, providing further insights into the possible mechanisms for its beneficial effects in patients with chronic heart failure. In an effort to find new pharmacologic therapies for the treatment of this patient population, studies of newer oral inotropic agents such as vesnarinone, pimobendan, and ibopamine have been disappointing. This paper reviews data published or presented in 1995 and 1996 examining the effects of digoxin and other oral inotropic agents in patients with chronic heart failure.