The role of digitalis in the future.

Pa, Poole-Wilson

doi:10.1111/j.1365-2125.1984.tb02592.x

Cited by 13 publications

(5 citation statements)

References 51 publications

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“…This conclusion differed from the find ings of many studies undertaken to deter mine whether digoxin was efficacious [8,11]. In general, these studies were not ran domized, double-blind or placebo-controlled trials.…”

Section: Evidence For Efficacy Of Digoxincontrasting

confidence: 50%

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Digitalis: Dead or Alive?

Poole‐Wilson¹

1988

Cardiology

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Over 200 years age, William Withering described the advantages which might be gained by the considered use of extracts of the foxglove, digitalis purpurea, in patients with congestive heart failure, particularly if the rhythm was irregular. In the subsequent years many patients undoubtedly benefited from the use of this drug. The introduction of diuretics in the present century provided an alternative, more effective and safer treatment for heart failure. More recently, angiotensin-converting enzyme inhibitors have become available. The use of digoxin in the treatment of heart failure is now indicated almost solely for the control of a fast heart rate in patients with atrial fibrillation.

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Section: Evidence For Efficacy Of Digoxincontrasting

confidence: 50%

“…MacKenzie [6] and Lewis [7] emphasized the value of digoxin in patients with atrial fibrillation. The use of the drug in sinus rhythm was and is contro versial [8].…”

Section: Evidence For Efficacy Of Digoxinmentioning

confidence: 99%

Digitalis: Dead or Alive?

Poole‐Wilson¹

1988

Cardiology

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“…The first detailed description of cardiac glycosides by William Withering was published in 1785 [7]. Numerous historical and medical reviews have been written recently [1,2,5,[8][9][10][11][12].…”

Section: Historymentioning

confidence: 99%

“…Several studies early this century reported that glycosides were effective in patients with heart failure and sinus rhythm [15][16][17], whilst Sir James MacKenzie and Sir Thomas Lewis, at least in his earlier work, were skeptical. This doubt has persisted to the present time and has resulted in many studies of the problem, using a variety of techniques and study designs [1,2,11]. The introduction of diuretics over 30 years ago [18] revolutionized the treatment of heart failure.…”

Section: Historymentioning

confidence: 99%

“…What is not agreed is the role of digoxin in the treatment of heart failure in patients who are in sinus rhythm. Cardiac glycosides exert a positive inotropic effect both in animals and humans [1][2][3][4][5], but the benefit of digoxin in patients with heart failure and sinus rhythm is minimal. The continuing use of digoxin is largely a reflection of past medical teaching and tradition.…”

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confidence: 99%

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Digoxin?A redundant drug in congestive cardiac failure

Poole‐Wilson

Robinson

1989

Cardiovasc Drug Ther

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Controversy continues concerning the use of digoxin as a positive inotropic agent in the treatment of heart failure in patients in sinus rhythm. Digoxin is properly used to control the heart rate in patients in atrial fibrillation. The findings from 14 uncontrolled and 6 controlled clinical trials have been examined. Digoxin does exert a small chronic positive inotropic effect. Although some individual patients, particularly those with fluid overload, appear to benefit from digoxin, controlled clinical trials in patients, most of whom have been treated with diuretics, have failed to demonstrate an increase of exercise capacity. No mortality trial has been attempted. Digoxin has the potential to be harmful in patients with ischemic heart disease. Alternative and safer therapies have been shown to be equal or superior to digoxin.

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Drug-prescribing patterns in old age

Kruse

Rampmaier

Frauenrath-Volkers

et al. 1991

Eur J Clin Pharmacol

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A prospective drug surveillance study was undertaken in 300 elderly patients admitted to a geriatric clinic. Prescribing patterns were determined on admission, at discharge and 3.6 and 18 months after discharge. Patients referred from long-term care institutions were on significantly more drugs than non-institutionalized subjects. A 34% reduction in the number of medicines prescribed at discharge was accompanied by a significant decrease in the mean number of prescriptions per patient, from 4.3 to 2.8, irrespective of whether the patient was institutionalized. Polypharmacy, defined by 5 or more concomitant drugs, declined from 43 to 17%. Dosage schedules were simplified in the majority of patients, as expressed by a significant decrease in the mean number of daily doses to be taken from 6.7 on admission to 4.4 at discharge. Cardiovascular drugs, diuretics and psychotropic drugs accounted for 64% of all drug prescriptions. At discharge, prescription frequencies were reduced for most medication categories, except diuretics and gastrointestinal drugs, which were being taken more often. The prescribing frequency of cardiac glycosides, the single most frequently prescribed drug class, decreased from 60 to 33% of the patients. Three months after discharge, prescribing patterns and frequencies were found to be very similar to the pre-admission situation. Eighteen months after discharge, overall drug use had increased by 15% compared to admission, and polypharmacy was recorded in 54% of patients. It is concluded that a substantial reduction in drug prescriptions was possible in the majority of elderly patients, particularly if they are institutionalized, on admission to a geriatric clinic.(ABSTRACT TRUNCATED AT 250 WORDS)

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The role of digitalis in the future.

Cited by 13 publications

References 51 publications

Digitalis: Dead or Alive?

Digitalis: Dead or Alive?

Digoxin?A redundant drug in congestive cardiac failure

Drug-prescribing patterns in old age

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