Digoxin therapy gets a class I indication for the treatment of symptomatic systolic congestive heart failure. The DIG (Digitalis Intervention Group) trial showed no mortality benefit; however, there was improvement in symptoms and fewer hospitalizations for heart failure.

Commonly, if systolic heart failure is present in combination with atrial fibrillation and an uncontrolled ventricular rate, digoxin therapy is utilized.

Digoxin is only used in diastolic heart failure if atrial fibrillation is present with uncontrolled ventricular rates.

Digoxin does have a class IIa indication to control heart rate in atrial fibrillation when used in conjunction with a beta-blocker or non-dihydropyridine calcium channel blocker.

Digoxin has a class IIb indication to be used as a sole agent to control heart rates in patients with atrial fibrillation and a class III indication (may be harmful) to be used as a sole agent to control heart rates in patients with paroxysmal atrial fibrillation.