Current and Future Controversies

Today, there is little doubt in the use of digitalis as the treatment of choice for the patient suffering from fast atrial fibrillation. The controversy arises,however, looking at glycosides as a treatment for congestive heart failure. This question is especially true when dealing with patients who have normal heart rhythm.

There are two major issues with the future use of digitalis. The first is the comparison of digitalis with other heart failure treatments.

Many investigators have argued that it is better to treat congestive heart failure with patients who have a regular heart rhythm, with diuretics instead of digitalis. There were two studies which studied this question. Both came to the conclusion that treatment with diuretics achieved the same result as did treatment with glycosides. Both these studies were poorly designed to be conclusive.

Other studies have shown that patients given diuretics to treat their symptoms, gain no added benefit if they take digitalis afterwards.

Another fator complicating this contreversy, is the recent introduction of vasodilators to the treatment of cardiac problems.

The fate of digitalis is in question. It was found that "In patients with heart failure associated with regular rhythm it has recently become clear that long-term digitalis therapy may not be required." (Mackenzie, 19IIb). All in all, the question of whether to continue to use glycosides as a treatment for heart failure lies on the continued research on the questions of:

-Do diuretics work better than glycosides.
-Whether digitalis is not necessary in the majority of cases.
-Whether digitalis is such a benefit to begin with.

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