Digitalis therapy in heart failure: a rational approach

Monitoring digoxin therapy in two long-term facilities

Digoxin monitoring was examined according to 13 criteria in two nursing homes: 1) an intermediate care facility (ICF) with private physicians, and 2) a skilled care (SCF) plus ICF with 3 housestaff physicians from a identify all patients receiving digoxin, 2) evaluate dosage patterns, 3) evaluate monitoring patterns, and 4) detect possible toxic reactions and determine whether management was appropriate. The calculated correct dosage of digoxin in both ICFs. More frequent monitoring of serum creatinine and potassium levels was associated with fewer symptoms of toxicity. Possible toxicity occurred in 46 percent of the SCF and in 68 and 71 percent of patients in the ICFs. Documented toxicity occurred in 18 percent of the SCF patients and in 16 and 10 percent of the ICF patients. Eighty percent of patients who had symptoms of digoxin toxicity were not examined or managed appropriately in the SCF, and 43 and 33 percent in the ICFs. Often standing orders had been assigned for drugs to treat nausea, vomiting or diarrhea. A number of possible drug interactions with digoxin were discovered. The participation of the pharmacist in nursing home care is discussed.

The role of furosemide alone and in combination with digoxin in the relief of symptoms of congestive heart failure

Clinical and cardiovascular responses to drug therapy with furosemide were compared with those to furosemide plus digoxin in 15 heart patients with sinus rhythm admitted to the hospital for the management of congestive heart failure. Except for two patients in the group treated with furosemide alone, who required the addition of intravenous furosemide for more complete relief of symptoms, the responses to the two therapeutic regimens were not significantly different. One patient in the digoxin-treated group developed atrial fibrillation with frequent ventricular premature beats and transient runs of bigeminal rhythm typical of digitalis toxicity, which disappeared as the dose of digoxin was lowered. Side effects were otherwise considered to be minor and similar in the two groups. The results support the view that the indications for digoxin as a positive inotropic agent in patients with congestive heart failure need to be reevaluated.