To the Editor.
—The article by Drs Kulick and Rahimtoola1 is to be praised for the strength of its references. Unfortunately, the same cannot be said for the strength of its conclusions.In congestive heart failure, as in other conditions, we treat patients to relieve their symptoms or to help them live longer. There is no evidence that digoxin will prolong the life of a patient with heart failure and systolic dysfunction who is well compensated on a diuretic or a diuretic—angiotensin-converting enzyme inhibitor (eg, enalapril maleate or lisinopril given once daily) regimen. Until relevant data become available, some physicians will begin digoxin early and others will reserve it until later in the patient's clinical course. Despite the 43 references supplied by the authors, no definitive clinical trial comparing those two strategies has been performed. Therefore, the authors' conclusions that digoxin be initiated early and that vasodilator therapy should