An Update on the Role of Digoxin in Older Adults with Chronic Heart Failure



Geriatrics and Aging. 2008;11(1):37-41. 

In This Article

Treatment of Systolic Heart Failure: Neurohormonal Blockade

The evidence-based recommendation for pharmacotherapy for chronic HF using neurohormonal antagonists is generally reserved for individuals with systolic HF or clinical HF with a low left ventricular ejection fraction.[2,6] These recommendations can be summarized as the use of an ACEI for those with systolic HF in the absence of a true contraindication such as angioedema or a past history of allergy or intolerance. Some degree of rise in serum creatinine is expected and should not be considered a contraindication or a past history of intolerance.[7,8] Individuals who cannot tolerate an ACEI should be prescribed an angiotensin receptor blocker. Patients with systolic HF should also be prescribed a beta-adrenergic receptor blocker that has been shown to reduce the risk of death in these patients, namely, metoprolol succinate extended release, carvedilol, and bisoprolol. There is no need to maximize the dose of an ACEI or an angiotensin receptor blocker before initiating a beta-blocker. Persons with advanced HF may also be treated with an aldosterone antagonist such as spironolactone, or eplerenone for those who cannot tolerate spironolactone. These drugs should be avoided in persons with advanced kidney disease and those with high serum potassium.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.