{"id":7725,"date":"2025-06-27T17:10:44","date_gmt":"2025-06-27T14:10:44","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=7725"},"modified":"2025-06-27T17:10:44","modified_gmt":"2025-06-27T14:10:44","slug":"can-cardiac-glycosides-digoxin-digitoxin-return-to-heart-failure-management","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/can-cardiac-glycosides-digoxin-digitoxin-return-to-heart-failure-management\/","title":{"rendered":"Can Cardiac Glycosides (Digoxin\/Digitoxin) Return to Heart Failure Management?"},"content":{"rendered":"
Can Cardiac Glycosides (Digoxin\/Digitoxin) Return to Heart Failure Management?<\/div>\n
<\/div>\n
Source: Medscape Medical News | June 24, 2025<\/div>\n
<\/div>\n
Key Points Summary:<\/div>\n
<\/div>\n
1. Historical Context:<\/div>\n
\u2022 Digoxin and digitoxin, derived from foxglove, have been used for centuries in cardiology.<\/span><\/div>\n
\u2022 Based on the 1997 DIG trial, digoxin reduced HF hospitalizations, but had no effect on all-cause mortality.<\/span><\/div>\n
\u2022 As modern therapies emerged, digoxin\u2019s guideline status was downgraded from Class I to Class IIb.<\/span><\/div>\n
\u00a0 \u00a0 \u00a0 .\u00a0 \u00a0 \u00a0 Key findings from the DIGIT-HF and DECISION trials\u2014both re-evaluating the role of cardiac glycosides in HFrEF\u2014are expected later this year, and will be essential in determining whether these agents merit renewed guideline support beyond limited use in patients with HFrEF and atrial fibrillation.<\/div>\n
<\/div>\n
2. Modern Trials Exploring Revival:<\/div>\n
<\/div>\n
DIGIT-HF Trial:<\/div>\n
\u2022 Design: 1212 HFrEF patients receiving digitoxin or placebo + contemporary GDMT \u201cFantastic Four.<\/span><\/div>\n
\u2022 Goal: Assess if low serum levels of digitoxin improve outcomes and are safe.<\/span><\/div>\n
\u2022 Key Context:<\/span><\/div>\n
\u2022 40% on ARNI, 70% on MRA.<\/span><\/div>\n
\u2022 64% had ICDs; 25% had CRT.<\/span><\/div>\n
\u2022 Preferred over digoxin for patients with renal impairment (digitoxin = hepatic clearance).<\/span><\/div>\n
\u2022 Special interest in AF + HFrEF patients needing rate control when \u03b2-blockers are insufficient.<\/span><\/div>\n
<\/div>\n
DECISION Trial:<\/div>\n
\u2022 Over 1000 symptomatic HF patients (LVEF <50%).<\/span><\/div>\n
\u2022 Uses low-dose digoxin (target 0.5\u20130.9 ng\/mL), avoiding higher levels linked to mortality in the DIG trial.<\/span><\/div>\n
\u2022 Enrolled more women to improve representation and analysis.<\/span><\/div>\n
<\/div>\n
3. Why Revisit Cardiac Glycosides?<\/div>\n
\u2022 Many HFrEF patients remain symptomatic despite full use of the \u201cFantastic Four\u201d:<\/span><\/div>\n
1. ARNI<\/span><\/div>\n
2. Beta-blockers<\/span><\/div>\n
3. MRAs<\/span><\/div>\n
4. SGLT2 inhibitors<\/span><\/div>\n
\u2022 In patients with AF and HFrEF, glycosides may still be valuable for rate control.<\/span><\/div>\n
<\/div>\n
4. Guideline Perspective \u2013 AHA 2022 (U.S.):<\/div>\n
\u2022 Cardiac glycosides can be considered in:<\/span><\/div>\n
\u2022 Symptomatic HFrEF patients despite optimal GDMT.<\/span><\/div>\n
\u2022 Patients who cannot tolerate full GDMT.<\/span><\/div>\n
\u2022 Goal: reduce HF hospitalizations, not mortality.<\/span><\/div>\n
<\/div>\n
Ongoing Questions & Caution:<\/div>\n
\u2022 DIGIT-HF is stratified by AF status and may offer insight into digoxin\u2019s role in AF + HFrEF.<\/span><\/div>\n
\u2022 However, not all patients in the trial were receiving the complete GDMT at baseline.<\/span><\/div>\n
\u2022 Experts caution that additional trials are needed before glycosides can regain strong guideline support.<\/span><\/div>\n
<\/div>\n
\u2022 https:\/\/www.medscape.com\/viewarticle\/xxx<\/a><\/span><\/div>\n","protected":false},"excerpt":{"rendered":"

Can Cardiac Glycosides (Digoxin\/Digitoxin) Return to Heart Failure Management? Source: Medscape Medical News | June 24, 2025 Key Points Summary: 1. Historical Context: \u2022 Digoxin and digitoxin, derived from foxglove, have been used for centuries in cardiology. \u2022 Based on the 1997 DIG trial, digoxin reduced HF hospitalizations, but had no effect on all-cause mortality. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7725","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7725","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=7725"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7725\/revisions"}],"predecessor-version":[{"id":7729,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7725\/revisions\/7729"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=7725"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=7725"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=7725"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}