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Congestive heart failure

Prevalence
Causes
Clinical features
Differential diagnosis
Investigations
Therapy
Prevention
Prognosis
Prevention

Consider giving patients with poor left ventricular function digoxin - even with a normal sinus rhythm a

Why?

  • It reduces hospital admissions, particularly from worsening heart failure, without reducing mortality. a
  • However, more patients are admitted with suspected digoxin toxicity. a
  • It is cost-effective. a

Digoxin reduces hospital admissions

Patient Treatment Comparison Outcome CER RRR
(95% CI)		 NNT
(95% CI)
  • symptomatic heart failure a
  • LV ejection fraction < 45%
  • normal sinus rhythm
digoxin placebo any hospital admission
at 3 years 		67% 4%
(1% to 7%) 		36
(20 to 200)
      hospital admission for worsening heart failure
at 3 years 		35% 23%
(17% to 28%) 		13
(10 to 18)
      hospital admission with suspected digoxin toxicity
at 3 years 		0.91% -120%
(-235% to -44%) 		-92
(-190 to -60)

 

Expiry date: June 2003
Levels of Evidence used in grading these guides

Author   CM   Ball
Reviewer   B   Lee
CAT Writers   CM   Ball , CJ   Wotton , A   Yates