rugs for diastolic heart failure have been tested in randomized studies of patients – largely because it wasn't recognized as a separate form of heart failure until more recently. "There are few evidenced–based recommendations for these patients," wrote the authors.
The results reported in Circulation are from a larger study conducted in the United States and Canada from 1991 to 1993 and had not been previously published.
The study involved patients with diastolic heart failure who were assigned to receive either digitalis, also known as digoxin, or a placebo. Digitalis slows the heart rate, helps eliminate fluid from body tissues, and strengthens the contraction of the heart muscle. Most patients were also receiving two common treatments for heart failure: diuretics and angiotensin-converting enzyme inhibitors.
Patients were followed for a mean of 37 months. The team of researchers, from 10 different medical centers, analyzed data from the study and found that digitalis had no effect on death from heart failure or any cause, or on hospitalizations related to heart failure or any cause.
There was a trend, which wasn't strong enough for researchers to know if it occurred by chance or was associated with use of digitalis, for patients to have reduced hospitalizations from worsening heart failure, but there was also a trend of increased hospitalizations for unstable angina.
The lead author on the report is Ali Ahmed, M.D., M.P.H., from the University of Alabama at Birmingham. Senior author is Mihai Gheorghiade, M.D., from Northwestern University.
"These results are somewhat of a paradigm shift," said Kitzman. "They show that although digitalis has no definite significant net benefit for diastolic heart failure, it also does no net harm. There is no need to avoid prescribing it, such as for atrial fibrillation, though other newer drugs are often used first."
Contact: Karen Richardson
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