Overview
- Researchers reported at the ESC Heart Failure 2026 congress that a patient-level meta-analysis of three randomized trials (DECISION, DIGIT-HF, DIG; 9,013 patients) found digitalis drugs such as digoxin or digitoxin cut the risk of cardiovascular death or first worsening heart failure event (HR 0.85; p<0.001), mainly by reducing first worsening events (HR 0.75).
- In the randomized, double-blind DECISION trial of 1,001 patients on contemporary therapy, low-dose digoxin did not significantly reduce the primary composite of total worsening events plus cardiovascular death over 36.5 months (rate ratio 0.81; p=0.133).
- A prespecified blinded withdrawal analysis that followed DECISION participants found clinical deterioration after stopping digoxin, with more cardiovascular deaths and heart failure events than after stopping placebo (rate ratio 7.37; p=0.012).
- Investigators targeted low blood levels of digoxin (0.5–0.9 ng/ml) and reported good tolerability, including in women and in people with atrial fibrillation, addressing past safety concerns linked to higher doses.
- UMCG researchers said the totality of evidence, published in Nature Medicine and JAMA and presented in Barcelona, could prompt a guideline review and broaden use of a drug that costs less than ten cents per day.