Inotropes in CHF: Role of digoxin

Digoxin is the most commonly used inotrope in the treatment of chronic heart failure. Its combined positive inotropic and neurohormonal inhibitory effects result in sustained long-term clinical and hemodynamic benefits, improvement in exercise capacity and quality of life, and prevention of clinical deterioration. Two recent multicenter trials clearly established the complementary hemodynamic and clinical benefits of chronic digoxin therapy when administered concurrently with diuretics and angiotensin-converting enzyme inhibitors. In contrast, orally active nonglycoside inotropes, some of which stimulate neuroendocrine activity, have generally failed to provide long-term clinical benefits and some have increased the risk of mortality. Orally effective dopaminergic agents are currently being developed, as are other inotropes with unique mechanisms of action.