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May 28, 2003

Optimal Digoxin Concentrations for Patients With Heart Failure—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(20):2643. doi:10.1001/jama.289.20.2643-a

To the Editor: Mr Rathore and colleagues1 found that, among men with heart failure and depressed left ventricular function, digoxin therapy in the serum digoxin concentration (SDC) range of 0.5 to 0.8 ng/mL was associated with decreased mortality as compared with either placebo or higher SDCs. However, because the study involved only patients in sinus rhythm, it did not address digoxin therapy in patients with heart failure and atrial fibrillation. Although digoxin is generally recommended for the treatment of heart failure in the presence of atrial fibrillation,2 the required SDCs reported in the guidelines by the task force of the European Society of Cardiology (ie, approximately 2.0 ng/mL) are generally higher than those SDCs that were found safe and effective by Rathore et al. This point is important because (1) no similar studies have been published on digoxin treatment for patients with heart failure and atrial fibrillation; (2) the prevalence of heart failure with atrial fibrillation increases with advancing age, and; (3) the incidence of digoxin toxicity is higher among the oldest patients.4

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