Despite a widely held belief that the heart drug digitalis shouldn't be given to patients with diastolic heart failure, a new analysis shows it is relatively safe.
"Contrary to conventional wisdom, digitalis did not have an overall detrimental effect. The study advances our understanding of both digitalis, the oldest known heart medicine, and of diastolic heart failure, the newest form of heart failure," said Dalane Kitzman, M.D., a professor of cardiology at Wake Forest University School of Medicine and a co-author on the report, published on-line in the journal Circulation.
Kitzman said the study, which involved 988 patients, is significant because it is one of the first to evaluate a treatment for diastolic heart failure, the most common type in older adults, which is expected to increase as the population ages.
There are an estimated 5 million heart failure patients in the United States, and about half have diastolic heart failure, in which the heart muscle is stiff and doesn't take in enough blood with each beat. The other type, systolic heart failure, is when the heart muscle is too weak to effectively pump blood out into the body.
In systolic heart failure, digitalis has been shown to have a number of benefits, including improving symptoms, quality of life, exercise tolerance, heart muscle contraction, and controlling atrial fibrillation, the most common heart rhythm abnormality in heart failure.
"However, its use in diastolic heart failure has been discouraged due to concerns based on small, anecdotal studies that it might precipitate early death," said Kitzman. "Our findings that it is relatively safe in this disorder allow it to be prescribed if needed for atrial fibrillation, and to be evaluated further to see if it has other benefits, such as improving symptoms, as it does for systolic heart failure."
Few drugs for diastolic heart failure have been tested in randomized studies of patients - largely because it wasn't recognized as a separate form of heart failure until more recently. "There are few evidenced-based recommendations for these patients," wrote the authors.
The results reported in Circulation are from a larger study conducted in the United States and Canada from 1991 to 1993 and had not been previously published.