What is the role of digoxin?
Digoxin is an add-on treatment option for patients in sinus rhythm with worsening heart failure symptoms despite optimised ACE inhibitor, beta-blocker and diuretic therapy.2 Evidence in support of digoxin is dominated by the DIG trial.27 This trial found fewer hospitalisations due to worsening heart failure in patients with CHF (LVEF <45%; n=6,800) receiving digoxin rather than placebo in addition to other therapies (26.8% vs. 34.7%; RR 0.72, 95% CI 0.66 to 0.79; NNT 13; P<0.001) over a mean of 37 months. However, there was no significant difference in all-cause mortality (digoxin 34.8%, placebo 35.1%).27 The DIG trial was conducted before evidence became available in support of beta-blockers, aldosterone antagonists and combined ACE inhibitor-A2RA treatment in CHF,2 and there are no directly comparable data for digoxin and these other strategies. Digoxin is also recommended as a treatment for patients with atrial fibrillation and any degree of heart failure in the current NICE guideli
