The retrospective cohort study performed by Gambassi et al1 helped confirmed what many geriatricians have suspected for some time, that the positive effects of angiotensin-converting enzyme (ACE) inhibitors in heart failure apply to the elderly patient. However, their conclusions are misleading. It is inappropriate to conclude that "digoxin has a detrimental effect in this population." While Gambassi and colleagues' data fairly convincingly demonstrate the positive effects of ACE inhibitors in patients who are using them compared with patients who are not using them but are taking digoxin instead, that does not imply that the use of digoxin itself is detrimental. It may have just been the lack of the use of ACE inhibitors in this group that explained their poorer outcome. I think that Gambassi and colleagues cover this appropriately in the body of their article, but the casual reader who just peruses the abstract could easily be misled.
Kontor JT. Heart Failure Therapy in the Elderly. Arch Intern Med. 2000;160(16):2546. doi: