Digitoxin Effective in Patients with Heart Failure and Reduced Ejection Fraction

An international, double-blind, placebo-controlled trial suggested that digitoxin modestly lowered the combined risk of death from any cause or hospital admission for worsening heart failure (HF) than placebo in patients with advanced HF receiving modern therapy. The trial evaluated digitoxin in 1,240 patients with chronic HF and reduced ejection fraction (≤40% with New York Heart Association [NYHA] III–IV or ≤30% with NYHA II). Patients were randomized 1:1 to digitoxin (at a starting dose of 0.07 mg daily) or placebo in addition to guideline-directed medical therapy and followed for a median of 36 months. In the modified intention-to-treat population (n=1,212), digitoxin reduced the composite risk of death or first hospitalization for worsening HF compared with placebo (39.5% vs. 44.1%). Death from any cause occurred in 27.2% vs. 29.5% (HR 0.86) and first hospitalization in 28.1% vs. 30.4% (HR 0.85). Serious adverse events were more frequent in the digitoxin group (4.7% vs. 2.8%). Cardiac glycosides such as digitoxin actions as positive inotropic agents and modulators of atrioventricular conduction. Source: https://www.nejm.org/