Drug therapy in older people with heart failure
Editor – We read with interest the review article by Mukhtar and Jackson entitled Drug therapy in older adults (part 2).1 In the article the authors provide an overview on the drug treatment of heart failure in older patients. However, we were surprised that digoxin, one of the oldest drugs in the management of heart failure was not mentioned as a treatment option. Clinical evidence is in favour of digoxin in diastolic heart failure as well as systolic heart failure through improvement of early diastolic function and possible reduction in sympathetic humoral activity.
The benefits are not restricted to patients with heart failure in atrial fibrillation but also in sinus rhythm. In a systematic review of 13 trials which included over 7,000 patients with heart failure in sinus rhythm, digitalis had a positive effect on improving symptoms and reducing hospitalisation.2
The earlier Digitalis Investigation Group trial had also showed, in addition to 6% less hospitalisation in the treatment, a trend toward a beneficial effect of digoxin in pump failure death, but this was offset by mortality from non-cardiovascular causes3.
Therefore in older patients with moderately severe heart failure who remain symptomatic despite optimum treatment with diuretics, angiotensin-converting-enzyme inhibitors and beta blockers, it is worthwhile considering the addition of digoxin. It is important to point out that the benefits of digoxin occur with low maintenance dosage which is usually between 62.5–125 μg daily.
The benefits of digoxin mentioned above cannot be over-emphasised in the vast majority of the older frailer population with heart failure. This is important as the NHS is aiming towards keeping the frail elderly in their own environment for as long as possible rather than hospitalisation. Clinicians working in acute frailty units are likely to come across more of these patients and can best serve this cohort of patients well by asking why they cannot be on digoxin. Every little helps especially on a frailty ward!
- © 2016 Royal College of Physicians
References
Article Tools
Citation Manager Formats
Jump to section
Related Articles
- No related articles found.
Cited By...
- No citing articles found.