Related Experiment Video
Updated: Sep 9, 2025
05:14
A Doxorubicin-Induced Murine Model of Dilated Cardiomyopathy In Vivo
Published on: May 16, 2020
4.8K
Digitoxin in Patients with Heart Failure and Reduced Ejection Fraction
Udo Bavendiek1, Anika Großhennig2, Johannes Schwab3,4
1Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
The New England Journal of Medicine
|August 29, 2025
Summary
Digitoxin treatment significantly reduced the combined risk of death or heart failure hospitalization in patients with reduced ejection fraction. This study establishes digitoxin as a potential therapy for heart failure management.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- The efficacy of digitoxin, a cardiac glycoside, for treating heart failure with reduced ejection fraction (HFrEF) remains unproven.
- Guideline-directed medical therapy (GDMT) is standard for HFrEF, but additional treatments are needed.
Purpose of the Study:
- To evaluate the therapeutic efficacy of digitoxin compared to placebo in patients with HFrEF receiving GDMT.
- To assess the impact of digitoxin on mortality and heart failure hospitalizations.
Main Methods:
- An international, double-blind, placebo-controlled trial randomized 1240 patients with HFrEF to receive either digitoxin or placebo.
- Patients had left ventricular ejection fraction ≤40% (NYHA class III-IV) or ≤30% (NYHA class II).
- The primary outcome was a composite of all-cause death or hospital admission for worsening heart failure.
Main Results:
- In the modified intention-to-treat population (1212 patients), digitoxin reduced the primary composite outcome by 18% (hazard ratio, 0.82; P=0.03).
- Over a median of 36 months, digitoxin showed a trend towards lower all-cause mortality (HR, 0.86) and heart failure hospitalizations (HR, 0.85).
- Serious adverse events were more frequent in the digitoxin group (4.7% vs. 2.8%).
Conclusions:
- Digitoxin treatment significantly lowered the combined risk of death or heart failure hospitalization in HFrEF patients on GDMT.
- Digitoxin represents a potential therapeutic option for managing heart failure with reduced ejection fraction.
- Further research may explore optimal dosing and long-term safety profiles.
Related Concept Videos
01:26Heart Failure Drugs: Inotropic Agents
717
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
717
01:30Heart Failure V: Medical Management
23
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
23
01:22Heart Failure Drugs: Diuretics
483
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
483
01:22Heart Failure VI: Adjunct Therapies
27
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
27
01:30Cardiomyopathy II: Dilated Cardiomyopathy
21
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
21
01:22Heart Failure Drugs: β-Blockers
434
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
434