Digoxin improves symptoms, quality of life, and functional capacity in
patients with mild to moderate CHF, regardless of underlying rhythm, but
it does not improve patient survival. Although diuretic use is the only
means of enabling salt and water excretion in patients with CHF, these
drugs should always be used in conjunction with other agents, usually
angiotensin-converting enzyme (ACE) inhibitors and beta-blockers. ACE inhibitors
are useful in managing left ventricular systolic dysfunction with or without
symptoms of CHF; they favorably affect remodeling and survival. The benefits
from a hydralazine-nitrate combination may result from biochemical, antioxidant,
and/or vasodilatory effects. However, the 2 drugs are not first-line treatments
prior to the use of ACE inhibitors. Because of the risk of death and lack of
efficacy data, intravenous infusion of positive inotropic agents is not
recommended for outpatients.
- Digoxin significantly improves survival of patients with CHF.
1. Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure. Am J Cardiol 1999;83:1A-38A.
2. Gomberg-Maitland M, Baran DA, Fuster V. Treatment of congestive heart failure:
guidelines for the primary care physician and the heart failure specialist.
Arch Intern Med 2001;161:342-52.
3. Heart failure. In: Arky RA, Kettyle WM, Hatem CJ, editors. MKSAP 12:
Cardiovascular medicine. Philadelphia: American College of Physicians - American
Society of Internal Medicine; 2001:38-49.
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