Digoxin

Abstract This chapter focuses on digoxin, one of many cardiac glycosides (also known as cardiotonic steroids) that have been studied to varying degrees over the years. Digoxin is used for ventricular rate control in patients with atrial fibrillation (AF), a common co-morbidity in patients with heart failure. A patient with heart failure who is taking digoxin is likely taking it for rate control rather than for heart failure itself. Digoxin remained the only treatment for heart failure until the introduction of intravenous mercurial diuretics in the 1950s. The use of digoxin as a treatment for patients with heart failure has declined ever since, with the emergence of medications with proven prognostic benefit. Despite the decline in its use, digoxin is still cautiously recommended by the European Society of Cardiology in its guidelines both for heart failure and for AF. In the heart failure guidelines, digoxin is recommended for the treatment of heart failure in patients in sinus rhythm who are symptomatic despite ‘triple therapy’ or for ventricular rate control in patients with heart failure and AF when other options have been exhausted.