On 5th May, the European Heart Journal (1) published a meta-analysis associating digitalis use with death in published patient cohorts of heart failure and/or atrial fibrillation. The analysis does not report any new findings, and the main conclusions are based on “observational data”.
The ESC guidelines on HF management (2) recommend either digoxin (or digoxin glycosides) to prevent hospitalizations due to HF decompensation and to improve breathlessness in HF patients who have poor heart function. They also recommend digitalis to slow ventricular rate in patients with atrial fibrillation. We believe that the current recommendations reflect the available evidence from clinical trials, prospectively designed to evaluate the effects of digoxin in HF patients. The analysis published by EHJ, as all meta-analyses, may be prone to some inherent drawbacks, which can have a strong impact on the validity of the final conclusion. In line with this consideration, the largest randomized trial of digitalis in heart failure patients, the DIG trial, did not find an increased mortality in patients randomized to digitalis.
The ESC will consider this new analysis of existing data, together with other recent reports on digitalis and cardiovascular outcomes, in the current re-write of the atrial fibrillation and heart failure guidelines. We do not see an immediate need to change the existing recommendations. Patients who are treated with digitalis and who want further advice on their treatment based on this analysis should see their physician for careful re-evaluation and further discussion.
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1. Digoxin-associated mortality: a systematic review and meta-analysis of the literature
2. ESC Guidelines on Acute and Chronic Heart Failure
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