(LifeWire) - In heart failure, a person's heart doesn't pump as efficiently as normal and doesn't send enough oxygen-rich blood throughout the body. Medications are generally the key to managing the condition. But for some patients, the cornerstone treatment of using drugs to ease blood flow and rid the body of excess fluid doesn't suffice.
Doctors may then turn to an older drug, digoxin, which increases the force of the heart's contractions, helping ease heart failure symptoms. Digoxin therapy is mainly recommended for patients with heart failure who continue to have symptoms despite optimal therapy with a beta blocker, ACE inhibitor or ARB, and a diuretic.
Digoxin, or digitalis, was first used in the 1780s as a remedy for what was then known as dropsy -- and now is termed edema -- excess fluid accumulation. Edema is one hallmark of heart failure. Other prominent symptoms include shortness of breath, lethargy and coughing.
Heart failure affects more than 5 million Americans and contributes to the deaths of 300,000 people annually. Most patients are over age 65, and about 20% of people over 40 will develop the condition at some point in their lives.
Heart failure can have many causes, including diabetes, high blood pressure and other cardiac conditions, such as prior heart attack or valve problems.
Although digoxin has been widely used in treating heart failure, only since the 1990s have researchers recognized many of its benefits and shortcomings.
Among the shortcomings: Large studies suggest that the drug does not lower the overall likelihood of dying from heart failure. Women using it may have a higher mortality rate than men, but this finding remains controversial.
In addition, the effectiveness of digoxin depends on getting the optimal dosage. So patients taking it must have frequent tests to monitor blood levels of the medication. As with many heart failure drugs, digoxin can have numerous side effects, including:
- nausea and vomiting
- stomach pain
- appetite loss
- fatigue or weakness
- slow or irregular heartbeat
- drowsiness
- fainting
- confusion
On the other hand, digoxin is a positive inotrope -- a compound that boosts muscle contractions (in this case, the heart muscle). As such, it's clearly helpful to those whose heart strength is compromised.
It can also help regulate a rapid or irregular heartbeat. It not only improves the symptoms of heart failure, but it can also help to decrease the number of patient hospitalizations.
Read more here about the treatment of heart failure.
Sources:
Ahmed, Ali, James B. Young, and Mihai Gheorghiade. "The Underuse of Digoxin in Heart Failure, and Approaches to Appropriate Use." Canadian Medical Association Journal 176:5(2007) 1 Dec. 2008 <http://www.cmaj.ca/cgi/content/full/176/5/641>.
"Digoxin: A Medicine for Heart Problems." familydoctor.org. Nov. 2006. American Academy of Family Physicians. 1 Dec. 2008 <http://familydoctor.org/online/famdocen/home/common/heartdisease/treatment/241.html>.
"Heart Failure Fact Sheet." cdc.gov. 30 Aug. 2006. Centers for Disease Control. 14 Oct. 2008 <http://www.cdc.gov/dhdsp/library/fs_heart_failure.htm>.
Heckman, George A., and Robert S. McKelvie. "Necessary Cautions When Considering Digoxin in Heart Failure." Canadian Medical Association Journal 176:5(2007) 1 Dec. 2008 <http://www.cmaj.ca/cgi/content/full/176/5/644>.
"Medications Commonly Used to Treat Heart Failure." americanheart.org. 2008. American Heart Association. 1 Dec. 2008 <http://www.americanheart.org/presenter.jhtml?identifier=118>.
Morris, Spencer A., H. Floyd Hatcher, and Deepa K. Reddy. "Digoxin Therapy for Heart Failure: An Update." American Family Physician 74(2006) 613-18. 1 Dec. 2008 <http://www.aafp.org/afp/20060815/613.html>.
