Related Experiment Video

Updated: Apr 14, 2026

Testing the Efficacy of Pharmacological Agents in a Pericardial Target Delivery Model in the Swine
10:05

Testing the Efficacy of Pharmacological Agents in a Pericardial Target Delivery Model in the Swine

Published on: July 7, 2016

9.0K

Cardiac glycosides in patients with heart failure and reduced ejection fraction: a systematic review and

Dayang Wang1,2, Xiaoqing Xu3, Jingyao Lu2

  • 1Institute of Cardiovascular Diseases, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.

Frontiers in Cardiovascular Medicine
|March 30, 2026
PubMed

Insights

Cardiac glycosides reduce heart failure hospitalizations in HFrEF patients but do not impact mortality. Digitoxin shows no significant advantage over digoxin for mortality or heart failure hospitalizations.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • Prognostic benefits of cardiac glycosides in heart failure with reduced ejection fraction (HFrEF) are debated.
  • Digitoxin's pharmacokinetic advantages over digoxin are known, but clinical efficacy remains unproven.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials (RCTs) on cardiac glycosides in HFrEF.
  • To compare the efficacy of digitoxin versus digoxin for mortality and heart failure hospitalizations.

Main Methods:

  • Systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science up to September 12, 2025.
  • Included RCTs comparing cardiac glycosides to placebo in HFrEF patients.
  • Primary outcome: all-cause mortality; Secondary outcome: heart failure hospitalization. Indirect comparison of digitoxin vs. digoxin.

Main Results:

  • Six RCTs with 8,488 patients were analyzed.
  • Cardiac glycosides significantly reduced heart failure hospitalization risk (HR=0.79, 95% CI [0.67-0.94]) versus placebo.
  • No significant difference in all-cause mortality (HR=0.98, 95% CI [0.92-1.04]) or between digitoxin and digoxin for mortality or hospitalization.

Conclusions:

  • Cardiac glycoside therapy may decrease heart failure hospitalization risk in HFrEF patients.
  • Digitoxin offers no significant advantage over digoxin regarding mortality or heart failure hospitalizations.
Abstract

Keywords:
cardiac glycosidesdigitoxindigoxinheart failure and reduced ejection fractionmeta-analysisprognosis

More Related Videos

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

11.1K
Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model14:24

Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model

Published on: January 21, 2018

12.3K

Related Concept Videos

Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

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...
2.0K
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

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...
1.2K
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
1.5K
Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

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,...
1.2K
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

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...
567
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

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,...
801