Intended for healthcare professionals

Rapid response to:

Practice Clinical updates

Non-acute heart failure management in primary care

BMJ 2024; 385 doi: (Published 05 April 2024) Cite this as: BMJ 2024;385:e077057

Rapid Response:

Don't forget Digoxin!

Dear Editor

I was curious as to the omission of Digoxin from this article on management of heart failure. It's still there in NICE guidance, and even recommended elsewhere as a potential first-line treatment in patients whose heart failure is linked with AF.

In clinical practice Digoxin can be useful for sedentary elderly patients who often cannot tolerate the hypotensive effects of ACEi/ARB/beta blockade/diuretics. While it has no evidence for prognostic benefit, the symptomatic improvement is often all that is being sought in this group of patients.

Competing interests: No competing interests

14 May 2024
Judah Eastwell
Healthy Prestatyn Iach, North Wales