Digoxin may mitigate worsening of rheumatic heart disease

Treatment with digoxin appears to reduce the risks of mortality and new-onset or worsening heart failure in patients with rheumatic heart disease (RHD), according to a study.

The study included 1,769 RHD patients (mean age 46 years, 72 percent female, 70 percent had atrial fibrillation or atrial flutter, 90 percent had NYHA class II to IV). These patients were randomly assigned to receive digoxin at 0.125–0.25 mg (n=885) or matching placebo (n=884). Treatment was administered orally, once daily.

The primary outcome was a composite of all-cause death or new-onset or worsening heart failure within 36 months of follow-up or until study end. The components of the primary outcome were also assessed individually.

Over a median follow-up was 2.1 years, the primary composite outcome occurred in 31.4 percent of patients treated with digoxin and 35.5 percent of those who received placebo (hazard ratio [HR], 0.82, 95 percent confidence interval [CI], 0.70–0.97; p=0.02).

New-onset or worsening heart failure was documented in 25.8 percent and 29.2 percent of patients in the digoxin and placebo groups, respectively (HR, 0.82, 95 percent CI, 0.69–0.98). Augmentation of oral or intravenous diuretics was used to manage most episodes of worsening heart failure without hospitalization.

Death from any cause was reported in 10 percent of patients in the digoxin group and in 10.4 percent in the placebo group (HR, 0.94, 95 percent CI, 0.70–1.26). Ten patients in the digoxin group and one in the placebo group permanently discontinued their medication.