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Digoxin, Clinical Evidence

Several studies have shown that digoxin improves symptoms in adults with heart failure.[Packer: 1993] No studies have shown that digoxin improves adult survival. Although digoxin is widely used to treat heart failure in children, little data supports, or refutes, its use. [Berman: 1983] [Kimball: 1991] Digoxin has been advocated for the treatment of heart failure in children associated with pulmonary overcirculation secondary to a left-to-right shunt. No data is available on the use of digoxin in children with heart failure caused by systemic left ventricular systolic function. Thus, recommendations can only be extrapolated from those for adults with left ventricular systolic function and heart failure. Current recommendations in adults are for digoxin to be used in symptomatic patients with heart failure in addition to diuretics, angiotensin-converting enzyme inhibitors, and beta-blockers.

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Helpful Articles

Madriago E, Silberbach M.
Heart failure in infants and children.
Pediatr Rev. 2010;31(1):4-12. PubMed abstract

Kay JD, Colan SD, Graham TP Jr.
Congestive heart failure in pediatric patients.
Am Heart J. 2001;142(5):923-8. PubMed abstract

Page Bibliography

Berman W Jr, Yabek SM, Dillon T, Niland C, Corlew S, Christensen D.
Effects of digoxin in infants with congested circulatory state due to a ventricular septal defect.
N Engl J Med. 1983;308(7):363-6. PubMed abstract

Kimball TR, Daniels SR, Meyer RA, Hannon DW, Tian J, Shukla R, Schwartz DC.
Effect of digoxin on contractility and symptoms in infants with a large ventricular septal defect.
Am J Cardiol. 1991;68(13):1377-82. PubMed abstract

Packer M, Gheorghiade M, Young JB, Costantini PJ, Adams KF, Cody RJ, Smith LK, Van Voorhees L, Gourley LA, Jolly MK.
Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. RADIANCE Study.
N Engl J Med. 1993;329(1):1-7. PubMed abstract