Why is the use of Digitalis Withering? Another Reason that we Need Medical Heart Failure Specialists

Contrary to popular opinion, William Withering did not discover digitalis nor was he the first to describe its use for heart failure. In 1785, the esteemed English botanist and physician wrote a pamphlet that summarized his experiences in 163 patients with dropsy. Yet, at the time, digitalis had been known to exert important pharmacological effects for 2000 years. In the first century, the Greek physician, Pedanius Dioscorides, noted the use of digitalis as a therapeutic agent; its application to heart failure was first recorded in print by Leonard Fuchs in 1542.1 Nevertheless, Withering was the first to systematically carry out clinical studies with the plant in a scientific manner, eliminating the superstition that had long surrounded it. Withering's work was ground-breaking, not because of what he discovered, but how he approached its evaluation. It was the first use of the scientific method for the characterization of a pharmaceutical. Do physicians currently celebrate the work of Withering when managing patients with heart failure? In the 1970s, digoxin was prescribed uniformly to patients with cardiac decompensation, generally in doses that they could barely tolerate. Digitalis toxicity was common; indeed, achieving it was often as part of the ‘trial-and-error’ approach to identify the proper dose for an individual. During the 1980s, physicians routinely prescribed lower doses of digoxin, and rates of overt intolerance diminished dramatically; yet, the drug still proved to be effective in randomized placebo-controlled trials. Its most striking benefit was its ability to prevent clinical deterioration.2 Treatment with digoxin reduced the risk of hospitalization for heart failure, and its withdrawal was accompanied by symptomatic worsening. Digoxin was the only drug with positive inotropic effects that did not increase the risk of cardiovascular death during long-term treatment in a general population of patients with chronic heart failure.2