Digitalis glycosides

Abstract The potential of digitalis glycosides in heart failure therapy has been long known. In the only large placebo-controlled, randomized trial, namely the DIG trial, digoxin had a neutral effect on overall mortality in patients with heart failure with reduced ejection fraction (HFrEF), but led to significantly reduced heart failure hospitalization. As standard HFrEF treatment in the DIG trial did not include beta-blockers and mineralocorticoid receptor antagonists, and the therapeutic window of digitalis glycosides is narrow, with a risk of serious side effects, the value of digitalis glycosides in HFrEF therapy is currently uncertain. Nevertheless, digitalis glycosides are still applied frequently worldwide, and this chapter provides recommendations for digitalis use in patients with HFrEF and/or atrial fibrillation. Two ongoing large trials will define the role of digitalis glycosides on top of modern HFrEF treatment: the Digoxin Evaluation in Chronic Heart Failure: Investigational Study In Outpatients in the Netherlands (DECISION) and the DIGitoxin to Improve ouTcomes in patients with advanced chronic Heart Failure (DIGIT-HF).