Digitoxin — A Reminder for Digoxin

Cardiac glycosides are among the oldest medications in cardiovascular care, prized for their actions as positive inotropic agents and modulators of atrioventricular conduction. In heart failure with reduced ejection fraction, their mechanistic rationale was so convincing that digitalis became a mainstay of treatment long before the initiation of large-scale trials investigating the effects of cardiac glycosides on morbidity and mortality. Early mechanistic and hemodynamic studies of cardiac glycosides, together with trials that showed improved exercise capacity and quality of life, reinforced their use. This evidence was bolstered by randomized withdrawal trials, in which discontinuation of digoxin led to rapid clinical . . .