digoxin and Vascular-Diseases

Heart failure (HF) is a leading cause of morbidity and mortality. Appropriate medical therapy using angiotensin converting enzyme inhibitors and beta-blockers improves outcomes in HF, whereas the role of digoxin is still not clearly defined. Digoxin is currently recommended for patients with HF who are symptomatic despite standard therapy and for controlling the ventricular rate in atrial fibrillation. Digoxin is a time-tested drug that accounts for 20 million drug prescriptions annually in the United States. It has favorable hemodynamic effects for patients with HF and atrial tachyarrhythmias. We conducted a systematic literature search for the current indications for digoxin. Despite extensive research and safety data, the literature suggests that digoxin is underused in clinical settings. Citing the literature where available, our review highlights the various clinical settings where digoxin is indicated. Despite difficulties with designing prospective studies in acute HF settings and lack of outcomes data, we believe that digoxin will continue to serve an important role in optimizing care in certain acute and chronic cardiac conditions.

Topics: Cardiotonic Agents; Digoxin; Heart; Heart Diseases; Humans; Hypertension, Pulmonary; Vascular Diseases

To document the presence and treatment of selected vascular risk factors in patients with vascular cognitive impairment and elements affecting undertreatment of vascular risk factors.. Secondary analysis of the Canadian Study of Health and Aging database, which is a national, representative, cross-sectional study of the epidemiologic distribution of dementia in elderly people in Canada.. Survey.. Institutionalized and community-dwelling elderly people.. Vascular risk factors, dementia diagnosed by standard methods, and medication use.. Treatable vascular risk factors occurred significantly more often in patients with vascular cognitive impairment (with and without dementia) than in patients with probable Alzheimer disease or normal cognitive function. For example, 76% of patients with vascular dementia and 57% of those with vascular cognitive impairment without dementia had a history of stroke, compared with only 5% of those with probable Alzheimer disease and 7% of those with no cognitive loss. (For hypertension, the comparable figures are 55%, 48%, 24%, and 38%, respectively.) Potential undertreatment of vascular risk factors had little effect on mean control of vascular risk factors. For example, the mean (+/- SD) systolic blood pressure in those being treated was 144 +/- 26 mm Hg, compared with 142 +/- 25 mm Hg in those not receiving pharmacological treatment. In each group (treated vs untreated), the proportion of patients with a systolic blood pressure higher than 160 mm Hg was 20% and 16%, respectively. Potential undertreatment occurred most often in those with severe dementia and those living in nursing homes.. Vascular risk factors occurred more commonly in patients with vascular cognitive impairment compared with other patients, including those with other forms of dementia. When present, such risk factors were often treated pharmacologically, except in patients with severe dementia and those in long-term care institutions. Undertreatment does not, in general, result in worsened risk factor control.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Aspirin; Cognition Disorders; Dementia; Diabetes Complications; Diabetes Mellitus; Digoxin; Female; Humans; Hypertension; Male; Risk Factors; Vascular Diseases

Topics: Adolescent; Adult; Cardiovascular Diseases; Digoxin; Enzyme-Linked Immunosorbent Assay; Female; Humans; Intestinal Absorption; Male; Medigoxin; Middle Aged; Vascular Diseases

Topics: Adrenal Cortex Hormones; Adult; Arm; Digoxin; Female; Furosemide; Humans; Leg; Photosensitivity Disorders; Quinidine; Rheumatic Heart Disease; Vascular Diseases

Topics: Digoxin; Electrocardiography; Humans; Infant; Kanamycin; Lung; Male; Organomercury Compounds; Penicillins; Pulmonary Artery; Radiography; Vascular Diseases

Topics: Clinical Laboratory Techniques; Deferoxamine; Diet; Diet, Reducing; Digoxin; Drug Therapy; Hematologic Diseases; Hemochromatosis; Outpatient Clinics, Hospital; Physical Examination; Vascular Diseases

Topics: Animals; Constriction; Digitalis; Digoxin; Dogs; Heart Failure; Pulmonary Artery; Pulmonary Circulation; Vascular Diseases