The Effect of Digoxin on Mortality in Congestive Heart Failure Patients in Normal Sinus Rhythm

Abstract

Digoxin is an antiarrhythmic medication that has been used to manage chronic heart failure. Despite more than 200 years of research, the role of digoxin in patients with heart failure and sinus rhythm remains controversial. Recent studies have shown digoxin to reduce heart failure associated morbidity without having any effect on mortality. The purpose of our study was to study the impact of digoxin on mortality in heart failure patients in sinus rhythm.

Objective

• Effect of digoxin on mortality in heart failure patients in sinus rhythm
• Study impact of covariates such as age, gender, race, previous MI, and NYHA class
 

Methods: Heart failure patients with LVEF ≤0.45 were randomly assigned to digoxin group (n=3392) or placebo group (n=3401) and were followed on 
average for 38.4 months. Patients were enrolled at multiple clinical centers in the United States and Canada.
 

Results: In the study, mortality was unaffected. There were 1180 deaths in the digoxin group (34.77%) and 1194 deaths in the placebo group (35.09%). The adjusted hazard ratio (AHR) for the digoxin group compared with placebo group was 0.981 (p=0.6425) which was not statistically significant. The unadjusted median survival time for the placebo group was 58.37 months. The median survival time for the treatment group could was not reported because the group did not reach 50% survival probability during the study.

Conclusions: After controlling for age, gender, race, previous MI, and NYHA functional class, we found no difference in the hazard of death between those receiving digoxin and those receiving placebo. Our study demonstrated that digoxin did not reduce the overall mortality and has no survival benefit in the management of chronic heart failure.