Randomized clinical trials have been conducted to explore the safety and efficacy of digitalis in the management of CHF. The first major trial showed an improvement in quality of life but no mortality benefit. A second major clinical trial revealed that treatment with digitalis diminished the combined end points of death and hos-pitalizations but did not specifically improve overall survival. Thus, no studies have demonstrated that digitalis therapy improves survival in CHF patients. However, digitalis does decrease morbidity by diminishing the number of admissions to the hospital for symptoms such as dyspnea (shortness of breath) and fatigue. Current guidelines for the treatment of CHF indicate that physicians must at least consider including digitalis in the regimen. The consensus now is to prescribe a dose that achieves a digitalis blood level of 0.8 to 1.2 ng/dL. This lower dose reduces the incidence of side effects while optimizing the benefit.
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