Digoxin remains useful in the management of chronic heart failure

Digoxin remains an important therapeutic option for the outpatient management of patients with chronic symptomatic heart failure caused by systolic dysfunction. Randomized control trials have convincingly confirmed its efficacy in improving ejection fraction, improving submaximal exercise capacity, and decreasing heart failure hospitalizations. The Digitalis Investigation Group trial confirmed its safety during long-term use. Repeat assessment of drug levels is unnecessary in most patients. Current consensus guidelines re;commend its use for patients in whom NYHA class II-IV symptoms persist despite conventional therapy with diuretics, angiotensin-converting enzyme inhibitors, and a beta-adrenergic blocker.