Does digoxin cause more harm than good?

Background: The most recent British National Formulary recommends digoxin therapy for patients with heart failure (HF) and/or supraventricular arrhythmias, particularly atrial fibrillation (AF) and atrial flutter. The positive inotropic and negative chronotropic effects of the drug are undoubtedly desirable when managing these conditions, yet the use of digoxin is decreasing in popularity among prescribers. Aim: The aim of this literature review is to evaluate the use of digoxin for treating HF and/or AF. It will highlight the benefits of digoxin as well as its potential risks. These should be considered by all prehospital staff when assessing patients who are prescribed digoxin. Conclusions: Digoxin has shown positive outcomes for reducing hospital admissions for patients with HF and/or AF. However, clinicians should be aware of the narrow therapeutic index, which results in a high incidence of digoxin toxicity. The adverse effects of digoxin use should be considered during prehospital assessment, inclusive of pro-arrhythmic and thromboembolic complications. Whether digoxin may result in harm depends on the age, underlying pathology and renal function of each individual patient.