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Low-dose digoxin may help people with heart failure avoid hospitalisation and potentially reduce the risk of death, according to three studies led by cardiologists at University Medical Center Groningen (UMCG) in the Netherlands.
The researchers say the findings could eventually influence heart failure treatment guidelines and make the inexpensive drug available to a much larger number of patients.
Heart failure is a serious and growing health problem in which the heart cannot pump blood as effectively as it should. The condition can cause severe breathlessness and fatigue and often results in repeated hospital admissions. More than 500,000 people in the Netherlands are estimated to have heart failure, with the number expected to rise in the coming years.
Current standard treatment relies on a combination of four medications, often referred to as the “Fantastic Four”. Researchers have long investigated whether digoxin could provide additional benefits as a fifth treatment.
Three UMCG studies have now provided evidence supporting that possibility. The findings were published in journals including Nature Medicine and the Journal of the American Medical Association (JAMA) and were presented at the ESC Heart Failure Congress in Barcelona.
One study involved 1,000 people with heart failure treated at 43 centres across the Netherlands. Half received a low dose of digoxin in addition to their usual treatment for an average of three years, while the remainder received a placebo.
Among patients receiving digoxin, deaths from cardiovascular disease and worsening heart failure were 19 per cent lower. However, the individual result did not reach statistical significance.
Researchers then combined the findings with data from two earlier studies in a meta-analysis involving a substantially larger number of patients. The combined analysis found a statistically significant benefit from digoxin, including among patients already receiving all four standard heart failure medications.
The most pronounced benefit was a reduction in hospital admissions for heart failure, which fell by an average of 25 per cent. The researchers also found low-dose digoxin to be safe and relatively easy to administer.
A third study examined about 600 of the original 1,000 participants who had been assigned to receive either digoxin or a placebo. It found that patients who had been taking digoxin and subsequently stopped the medication experienced significantly more problems during the first six weeks than those who had never received it.
Among 288 patients who had been taking digoxin, 14 were hospitalised or died after the drug was discontinued.
The researchers stressed that the findings following discontinuation do not by themselves prove that digoxin is effective. Nevertheless, they described the magnitude and timing of the effect as notable and unexpected.
The researchers believe the combined evidence strengthens the case for considering low-dose digoxin as an additional treatment option for heart failure, although further evaluation and consideration by treatment guideline committees would be needed before any changes to standard care.