UPDATE ON DIGOXIN AND OTHER ORAL POSITIVE INOTROPIC AGENTS FOR CHRONIC HEART-FAILURE

The benefit of digoxin in chronic heart failure has been debated ferve ntly 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 th e effects of digoxin in patients with chronic heart failure. In the 19 80s, interest in digoxin was renewed after several trials with oral in otropic agents demonstrated increased mortality. Recently, several tri als have studied the hemodynamic, neurohormonal, and clinical effects of digoxin, providing further insights into the possible mechanisms fo r 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 ves narinone, pimobendan, and ibopamine have been disappointing. This pape r reviews data published or presented in 1995 and 1996 examining the e ffects of digoxin and other oral inotropic agents in patients with chr onic heart failure.