Digitalis preparations have been used for centuries. Digoxin is an agent that is readily available, can be administered acutely and long-term, intravenously or orally, is safe and may be beneficial in both acute and chronic heart failure (HF). It may be an ideal drug for the treatment of acute heart failure syndromes and warrants further investigation in large clinical trials. The role of digoxin in acute and chronic HF was discussed at the 2008 European Society of Cardiology Working Group on Acute Cardiac Care Meeting held in Versailles, France from 25-28 October 2008. This report represents a summary of the presentation at this meeting.