Digoxin was almost Abandoned in HFrEF Therapy. Is that Entirely Justified?

Digoxin is a positive inotropic agent, the only one suitable for chronic oral administration in patients with systolic heart failure (HFrEF<45-50%) with or without atrial fibrillation. Neuro-humoral properties are also significant by suppressing excessive activity of the sympathetic and renin-aldosterone systems. Numerous studies confirm that it achieves exceptional hemodynamic effects by increasing EJECTION FRACTION (EF), cardiac index by reducing pulmonary capillary pressure. It slows down the heart and neutrally affects blood pressure. Therefore, unlike beta-blockers and ACEs / ARBs, it can be safely used in patients with lower blood pressure. Digoxin is also associated with an improvement in renal function, estimated to increase glomerular filtration rate by 20%. Therefore, unlike renin-angiotensin-aldosterone inhibitors, it can be administered to patients with borderline renal function without the risk of further renal impairment (1,2,3,4,5).

The authors declare no conflict of interest.

Not applicable

The datasets used in this study are openly available at [repository link] and the source code is available on GitHub at [GitHub link].

This work did not receive any external funding.