We thank Professor Tauchnitz for his comments on our article (1). In our opinion, digitalis is a reserve medication. For this reason, in the national disease management guideline on chronic heart failure, we list digitalis only after basic medication and medication for selected patient groups in the third section, “Further medications” and make merely an open “can” recommendation (2). We see its value in the control of the resting heart rate in atrial tachyarrhythmias that cannot be controlled with betablockers only. We made a conscious decision in favor of the term “digitalis glycosides”, in order to make clear that in our opinion, digitoxin and semisynthetic digoxin derivatives (beta-acetyldigoxin, metildigoxin) can also be used, although data from prospective randomized studies are available for digoxin only (3). In the background text of the guideline, we mention the narrow therapeutic spectrum for digoxin and advise cautious use in elderly, female patients, and in patients with impaired renal function. Especially in the latter patients, clear preference should be given to digitoxin (2). These details were not included in our article in Deutsches Ärzteblatt International. We welcome the fact that a publicly funded study is investigating the importance of digitoxin as an addition to the currently used, guideline conform medications. We cannot, however, consider unpublished interim results for the guideline. Once the results of the DIGIT-HF study (4) are published, we will of course include the results into the update of the national disease management guideline on chronic heart failure.

DOI: 10.3238/arztebl.2018.0285b

On behalf of the authors

Peggy Prien

Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin

prien@azq.de

Conflict of interest statement

All authors declare that no conflict of interest exists.

1.
Edelmann F, Knosalla C, Mörike K, Muth C, Prien P, Störk S: Clinical practice guideline: Chronic heart failure. Dtsch Arztebl Int 2018; 115: 124–30. VOLLTEXT
2.
Bundes­ärzte­kammer (BÄK), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Kassenärztliche Bundesvereinigung (KBV): Nationale VersorgungsLeitlinie Chronische Herzinsuffizienz – Langfassung, 2nd edition. Version 2. doi.org/10.6101/AZQ/000390 (last accessed on 22 March 2018).
3.
Hood WB, Dans AL, Guyatt GH, et al.: Digitalis for treatment of heart failure in patients in sinus rhythm. Cochrane Database Syst Rev 2014; (4): CD002901 CrossRef
4.
www.clinicaltrialsregister.eu/ctr-search/trial/2013–005326–38/DE . (last accessed on 22 March 2018).
1.Edelmann F, Knosalla C, Mörike K, Muth C, Prien P, Störk S: Clinical practice guideline: Chronic heart failure. Dtsch Arztebl Int 2018; 115: 124–30. VOLLTEXT
2.Bundes­ärzte­kammer (BÄK), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Kassenärztliche Bundesvereinigung (KBV): Nationale VersorgungsLeitlinie Chronische Herzinsuffizienz – Langfassung, 2nd edition. Version 2. doi.org/10.6101/AZQ/000390 (last accessed on 22 March 2018).
3.Hood WB, Dans AL, Guyatt GH, et al.: Digitalis for treatment of heart failure in patients in sinus rhythm. Cochrane Database Syst Rev 2014; (4): CD002901 CrossRef
4. www.clinicaltrialsregister.eu/ctr-search/trial/2013–005326–38/DE . (last accessed on 22 March 2018).

    Deutsches Ärzteblatt international

    Info

    Specialities