Well, unfortunately, I am right next to positive that it's not a performance or software issue. But in the interest of full disclosure, here goes
I am running with 18GB of RAM (lots of AE and Premiere usage) in triple channel.
The OS hard drive has 676 GB free of 931 GB.
The PSU is 720W.
CPU is Intel Core i7 930 (no overclocking used on either RAM or CPU, for the record).
Running SLI with two Nvidia GTS 250 cards. (if you're curious, I have attempted to use just one to see if it would resolve the issue, obviously to no avail)
When it was working, I simply used the Windows 7 "Playback Devices" to choose my active device, though most of the time (including when it failed) I just had the digital audio connected.
And finally, just a reminder, it's not simply the digital audio passed through the HDMI on the video card that quit working, but the onboard coax and optical outputs as well. Incidentally, you might be surprised to know that all those outputs (the HDMI header, the coax, and the optical) are all considered the same device by Windows or the Realtek utility, and they WILL all output a signal simultaneously (when it worked, I used this function so that I didn't have to have my HDTV on in order to hear audio, and could simply switch my AV receiver input over to the optical).