Are physicians prematurely condemning digitalis because the "drug lag" has created a hunger for new cardiovascular agents? Advances in clinical science do require continued refinement of indications and use of the digitalis glycosides. The classic indication for universal prescription, "congestive heart failure," must be more finely tuned.1 When the etiologic determinants of failure are pulmonary, endocrine, hypertension, mechanical, or muscle replacement, considerable evidence indicates that digitalis will be slightly effective or ineffective. But when affliction of left ventricular myocardium is the principal culprit, the weight of scientific evidence supports the therapeutic efficacy of the digitalis glycosides.2
Studies not yet carried out will compare the relative merits of other modes of therapy with digitalis for immediate and long-term effects, morbidity, and mortality. Afterload reduction has been impressive, particularly in subsets of patients shown to respond poorly to digitalis therapy. Whether these new agents will be as convenient and effective