The use of digitalis preparations for treatment of cardiac maladies has been debated for centuries. Controversy regarding their effect on mortality has been the primary issue, given their relatively narrow toxic-therapeutic ratio. This led to the Digitalis Investigation Group trial, organized and conducted by the National Heart, Lung, and Blood Institute and the Department of Veterans Affairs. The trial, which involved patients with chronic heart failure and in sinus rhythm, demonstrated that, although digoxin did not affect survival, it was effective at reducing hospitalizations of patients receiving standard therapy—consisting of diuretics and angiotensin-converting enzyme (ACE) inhibitors—for heart failure.1 As a result, the US Food and Drug Administration granted regulatory approval to digoxin for the treatment of heart failure and atrial fibrillation in 1997.2
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