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Effect of oral digoxin in high-risk heart failure patients: a pre-specified subgroup analysis of the DIG trial

Mihai Gheorghiade1, Kanan Patel, Gerasimos Filippatos

  • 1Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

European Journal of Heart Failure
|January 29, 2013
PubMed

Insights

Digoxin significantly reduced heart failure (HF) hospitalizations and deaths in high-risk patients. These benefits were observed in patients with severe symptoms (NYHA class III-IV), low ejection fraction (LVEF <25%), or enlarged heart (CTR >55%).

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • The Digitalis Investigation Group (DIG) trial previously suggested benefits of digoxin in heart failure (HF).
  • However, detailed 2-year outcomes in specific high-risk HF subgroups were not fully presented.
  • This study aimed to analyze these specific subgroup outcomes.

Purpose of the Study:

  • To evaluate the effect of digoxin on 2-year outcomes in high-risk subgroups of patients with chronic heart failure.
  • Specifically, to assess HF death/hospitalization and all-cause death/hospitalization.

Main Methods:

  • Analysis of data from the DIG trial involving 6800 patients with chronic HF.
  • Focus on three pre-specified high-risk subgroups: NYHA class III-IV, LVEF <25%, and CTR >55%.
  • Comparison of 2-year outcomes between digoxin and placebo groups within these subgroups.

Main Results:

  • Digoxin significantly reduced the composite endpoint of HF mortality or HF hospitalization in all three high-risk subgroups (NYHA III-IV, LVEF <25%, CTR >55%).
  • Hazard ratios for this endpoint ranged from 0.61 to 0.65 (P < 0.001) in favor of digoxin.
  • Digoxin also significantly reduced 2-year all-cause mortality or all-cause hospitalization in these subgroups (P values ranging from 0.001 to 0.012).

Conclusions:

  • Digoxin demonstrates significant benefits in improving outcomes for chronic heart failure patients with severe symptoms (NYHA class III-IV), reduced left ventricular ejection fraction (LVEF <25%), or increased cardiothoracic ratio (CTR >55%).
  • These findings support the consideration of digoxin in managing these high-risk HF populations.
Abstract

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