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To the Editor: Mr Rathore and colleagues¹ found that, among men with heart failure and depressed left ventricular function, digoxin therapy in the serum digoxin concentration (SDC) range of 0.5 to 0.8 ng/mL was associated with decreased mortality as compared with either placebo or higher SDCs. However, because the study involved only patients in sinus rhythm, it did not address digoxin therapy in patients with heart failure and atrial fibrillation. Although digoxin is generally recommended for the treatment of heart failure in the presence of atrial fibrillation,² the required SDCs reported in the guidelines by the task force of the European Society of Cardiology (ie, approximately 2.0 ng/mL) are generally higher than those SDCs that were found safe and effective by Rathore et al. This point is important because (1) no similar studies have been published on digoxin treatment for patients with heart failure and atrial fibrillation; (2) the prevalence . . . [Full Text of this Article]

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