{"id":8472,"date":"2025-09-02T12:16:34","date_gmt":"2025-09-02T09:16:34","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8472"},"modified":"2025-09-02T12:16:34","modified_gmt":"2025-09-02T09:16:34","slug":"digit-hf-trial","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/digit-hf-trial\/","title":{"rendered":"DIGIT-HF Trial\u00a0"},"content":{"rendered":"
DIGIT-HF Trial<\/div>\n
<\/div>\n
Source: Medical News \u2013 ESC 2025. August 29,2025<\/div>\n
<\/div>\n
1. Trial Design<\/span><\/div>\n
\u2022 DIGIT-HF: Randomized, placebo-controlled trial (8+ years, 1240 patients, LVEF \u2264 40%, symptomatic HFrEF).<\/span><\/div>\n
\u2022 Intervention: Digitoxin added to standard HF therapy vs placebo.<\/span><\/div>\n
\u2022 Median follow-up: 3 years.<\/span><\/div>\n
2. Primary Results<\/span><\/div>\n
\u2022 Event (death or first HF hospitalization): 39.5% digitoxin vs 44.1% placebo.<\/span><\/div>\n
\u2022 Absolute risk reduction: 4.6% (NNT = 22).<\/span><\/div>\n
\u2022 Relative risk reduction: 18% (HR 0.82; 95% CI 0.69\u20130.98; P = 0.03).<\/span><\/div>\n
\u2022 Subgroup benefit: stronger in patients with SBP <120 mmHg and HR \u226575 bpm.<\/span><\/div>\n
3. Safety<\/span><\/div>\n
\u2022 Serious adverse events: 4.7% digitoxin vs 2.8% placebo.<\/span><\/div>\n
\u2022 No increase in sudden cardiac death.<\/span><\/div>\n
\u2022 Safety signal reassures against past fears of harm from cardiac glycosides.<\/span><\/div>\n
4. Key Messages (Mandrola\u2019s Five Lessons)<\/span><\/div>\n
\u2022 Safety confirmed: Past harm signals were likely due to observational bias.<\/span><\/div>\n
\u2022 Benefit despite good background therapy: Effect added on top of beta-blockers, ARNI, MRA; only ~20% were on SGLT2i.<\/span><\/div>\n
\u2022 Meaningful effect size: Nearly 5% absolute risk reduction, comparable to SGLT2 trials, at very low cost.<\/span><\/div>\n
\u2022 AF subgroup: ~30% had AF; effect size similar \u2192 raises question if glycosides should be first for rate control in AF + HFrEF.<\/span><\/div>\n
\u2022 Statistical fragility: Results are significant but borderline (upper CI 0.98; P = .03; modest event numbers).<\/span><\/div>\n
5. Digitoxin vs Digoxin<\/span><\/div>\n
\u2022 Both inhibit Na\u207a\/K\u207a-ATPase \u2192 positive inotropy + neurohormonal modulation.<\/span><\/div>\n
\u2022 Digitoxin: steadier blood levels, less affected by kidney function (extra enterohepatic clearance).<\/span><\/div>\n
\u2022 Digoxin: available in US, but harder to monitor in routine care.<\/span><\/div>\n
\u2022 Ongoing Dutch DECISION trial will test digoxin specifically in HFrEF.<\/span><\/div>\n
6. Clinical Implications<\/span><\/div>\n
\u2022 Digitoxin may re-enter discussion for HFrEF therapy, especially in cost-constrained settings.<\/span><\/div>\n
\u2022 Raises question: should HFrEF patients now get five core drugs instead of four?<\/span><\/div>\n
\u2022 Potentially useful in AF + HFrEF when beta-blockers are limited.<\/span><\/div>\n
7. Limitations<\/span><\/div>\n
\u2022 Borderline statistical robustness.<\/span><\/div>\n
\u2022 Some loss to follow-up (17 digitoxin vs 8 placebo).<\/span><\/div>\n
\u2022 Unclear if findings translate directly to digoxin use in the US.<\/span><\/div>\n
<\/div>\n
Conclusion:<\/div>\n
DIGIT-HF revives interest in cardiac glycosides. Digitoxin showed statistically significant, clinically relevant benefit in HFrEF on top of modern therapy, with no major safety concerns. But statistical fragility and differences from digoxin mean more evidence is needed before routine global adoption.<\/div>\n
<\/div>\n
https:\/\/click.mail.medscape.com\/?qs=a275f6733bc75e6f4fc3334d705bb8ac3c228d3041e0234f3a45f7d6093b3fcc3f57e1c1bb03b62996f129f0814c3a89fdde7a66237a04323180c4947e5c257a<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

DIGIT-HF Trial Source: Medical News \u2013 ESC 2025. August 29,2025 1. Trial Design \u2022 DIGIT-HF: Randomized, placebo-controlled trial (8+ years, 1240 patients, LVEF \u2264 40%, symptomatic HFrEF). \u2022 Intervention: Digitoxin added to standard HF therapy vs placebo. \u2022 Median follow-up: 3 years. 2. Primary Results \u2022 Event (death or first HF hospitalization): 39.5% digitoxin vs […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8472","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8472","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\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8472"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8472\/revisions"}],"predecessor-version":[{"id":8473,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8472\/revisions\/8473"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8472"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8472"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8472"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}