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To what extent do congestive heart failure patients in sinus rhythm benefit from digoxin therapy? A systematic

R Jaeschke1, A D Oxman, G H Guyatt

  • 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

The American Journal of Medicine
|March 1, 1990
PubMed

Insights

Digoxin offers a clinically significant benefit for about one in nine patients with congestive heart failure (CHF) and sinus rhythm. Predictors of benefit include a third heart sound and CHF severity.

Area of Science:

  • Cardiology
  • Clinical Pharmacology

Background:

  • Congestive heart failure (CHF) remains a significant cause of morbidity and mortality.
  • Digoxin has been a cornerstone therapy for heart failure, but its role in patients with sinus rhythm requires ongoing evaluation.

Purpose of the Study:

  • To reassess the efficacy of digoxin in treating congestive heart failure (CHF) specifically in patients with normal sinus rhythm.
  • To quantitatively evaluate the clinical utility of digoxin based on recent randomized controlled trial (RCT) data.

Main Methods:

  • A comprehensive literature search was conducted using the MEDLINE database.
  • Seven high-quality, double-blind randomized controlled trials were identified and included in this meta-analysis.
  • Study quality, patient populations, interventions, and outcomes were systematically extracted and analyzed.

Main Results:

  • Digoxin use was associated with a significantly reduced odds ratio (0.28; 95% CI, 0.16-0.49) for CHF deterioration compared to placebo.
  • Key predictors of digoxin benefit included the presence of a third heart sound and more severe or prolonged CHF.

Conclusions:

  • Evidence from seven methodologically sound trials indicates that approximately 11% (1 in 9) of patients with CHF and sinus rhythm experience a meaningful clinical benefit from digoxin.
  • The confidence interval for this benefit ranges from 1 in 33 to 1 in 5 patients.
Abstract

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