К рекомендациям, так к рекомендациям...))
ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure)
Drugs Recommended for Routine Use.
Most patients with symptomatic left ventricular dysfunction should be routinely managed with a combination of 4 types of drugs: a diuretic, an ACE inhibitor, a beta-adrenergic blocker, and (usually) digitalis (21). T
Therapy with digoxin may be initiated at any time to reduce symptoms and enhance exercise tolerance.
Ну и так, немного для общего развития...
Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc a-n-a-l-y-s-i-s of the DIG trial
Digoxin at SDC 0.5–0.9 ng/mL reduces mortality and hospitalizations in all HF patients, including those with preserved systolic function. At higher SDC, digoxin reduces HF hospitalization but has no effect on mortality or all-cause hospitalizations.
Digitalis is the oldest and probably the least expensive drug for the management of HF. Yet, despite FDA approval and guideline recommendations, there has been a recent decline in the use of digoxin in HF patients.9–11,32 The recent ACC/AHA HF guidelines have also downgraded the role of digoxin in HF care, although promoting expensive device-based therapies with selective indications.12 This change in policy and practice regarding digoxin use appears to be due in part to lack of mortality benefit,31,33 in particular, in those with PSF.4 Despite recent evidence to the contrary,14,34 a widely publicized earlier study questioning the safety of digoxin in women35 also likely played a role. Finally, availability of newer neurohormonal antagonists such as beta-blockers and aldosterone antagonists,4 lack of industry sponsorship for digoxin, and aggressive promotion of expensive devices with selective indications10,11 have further slighted the role of digoxin in HF care. However, our data demonstrate that in ambulatory men and women with chronic stable HF and impaired or preserved systolic function, use of digoxin was associated with >30% reduction in HF hospitalization regardless of SDC and significant reduction in mortality and hospitalizations from all causes at low SDC. This is important as HF is one of the major causes of hospitalization, especially among older adults, and HF hospitalizations are expensive and associated with poor patient outcomes.
Our findings support a more expanded role of digoxin in HF. Digoxin should be used in systolic HF patients with or without atrial fibrillation who continue to remain symptomatic despite therapy with ACE-inhibitors or angiotensin receptor blockers (ARBs), and beta-blockers, or for those who cannot afford or tolerate these drugs. First, specifically, digoxin should be used for relief of HF symptoms before considering aggressive therapy with high-dose non-potassium-sparing diuretics, as these drugs may increase mortality and hospitalizations.36,37 Secondly, digoxin should be considered before initiating an aldosterone antagonist as these drugs often cause hyperkalaemia.38 Thirdly, digoxin should be prescribed before adding an ARB to an ACE-inhibitor. In the Val-HeFT and CHARM-added trials, addition of ARBs, which are expensive, did not result in reduction in mortality and was associated with increased adverse effects.32,39 Finally, digoxin should be tried before considering cardiac resynchronization therapy (CRT), which is invasive and costly.10,11,40 In addition, CRT is reserved for systolic HF patients with wide QRS complex, and response to CRT is often unpredictable.