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Should we SHIFT our thinking about digoxin? Observations on ivabradine and heart rate reduction in heart failure

Davide Castagno1, Mark C Petrie, Brian Claggett

  • 1Division of Cardiology, Department of Internal Medicine, University of Turin, Turin, Italy.

European Heart Journal
|March 13, 2012
PubMed

Insights

Digoxin may offer similar heart failure benefits as ivabradine. A retrospective analysis suggests digoxin provides comparable risk reduction for cardiovascular death or heart failure hospitalizations. Further reappraisal of digoxin in heart failure treatment is warranted.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart rate plays a crucial role in heart failure with reduced ejection fraction (HFrEF).
  • The Systolic Heart failure treatment with the I(f) inhibitor ivabradine Trial (SHIFT) highlighted heart rate reduction's impact on outcomes.
  • Digoxin is an established heart rate-lowering medication.

Purpose of the Study:

  • To compare the efficacy of digoxin with ivabradine in reducing cardiovascular death or heart failure hospitalizations.
  • To re-evaluate the role of digoxin in HFrEF management.

Main Methods:

  • Retrospective analysis of the Digitalis Investigation Group (DIG) Trial.
  • Comparison of digoxin's effect on the primary composite endpoint (cardiovascular death or hospital admission for worsening heart failure) with ivabradine's effect from the SHIFT trial.

Main Results:

  • Digoxin demonstrated a risk reduction in the composite outcome comparable to that of ivabradine.
  • Similar risk reductions were observed for the individual components of the composite endpoint.

Conclusions:

  • The findings suggest that digoxin may provide similar clinical benefits to ivabradine in HFrEF patients.
  • There may be a need to reconsider the current clinical standing of digoxin for heart failure treatment.
Abstract

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