Digoxin in Rheumatic Heart Disease
Digoxin and Clinical Outcomes in Rheumatic Heart Disease (Dig-RHD)
Presented by Ganesan Karthikeyan — All India Institute of Medical Sciences
Subspecialty: Heart Failure
Published in ACC.26 Late-Breaking
Key Result
Digoxin reduced the composite of death or new/worsening HF by 18% in rheumatic heart disease — first randomized trial of digoxin in RHD. Toxicity was rare (1%) with no related deaths.
What did this trial find?
The Dig-RHD trial was the first randomized, placebo-controlled trial of digoxin in rheumatic heart disease, randomizing 1,769 patients across 12 sites in India. Digoxin reduced the composite of all-cause death or new/worsening heart failure by 18%, driven primarily by reduction in heart failure events, with rare toxicity (1%) and no related deaths. The trial is globally significant given that RHD predominantly affects low- and middle-income countries with few evidence-based treatment options. Quote supply is limited, with coverage primarily from the ACC summary featuring the lead author's comments and no editorials or outside expert reactions yet identified.
Why does this trial matter?
Mostly straightforward coverage with very limited quote supply. The only directly attributable quote about the Dig-RHD trial itself comes from the lead author via the ACC news summary. There are no editorials, no named outside commentators reacting specifically to this trial, and no conference discussant quotes available. The Fonarow quote provides general context about glycoside guidelines but does not specifically reference Dig-RHD. This is a globally important but niche trial that has not yet generated the editorial and expert commentary ecosystem seen with higher-profile late-breakers.
Study Design
Double-blind, placebo-controlled, randomized trial across 12 sites in India (N=1,769)
Clinical Implications
Digoxin remains a safe and effective treatment option for rheumatic heart disease, particularly relevant for low- and middle-income countries where RHD remains prevalent and expensive therapies are inaccessible.
Abstract
The Dig-RHD trial was a double-blind, placebo-controlled trial conducted across 12 sites in India from 2022-2025, randomizing 1,769 patients with symptomatic rheumatic heart disease. Mean age was 46 years, 72% women, and 34% were already taking digoxin at baseline. Digoxin was associated with an 18% reduction in the composite primary endpoint of all-cause death or new/worsening heart failure, driven primarily by reduction in new/worsening HF. There was no significant mortality difference. The secondary composite (HF-related death and new/worsening HF) was similarly reduced by 18%. Toxicity was uncommon (1%) with no related hospitalizations or deaths. Benefits were consistent across subgroups with possible greater benefit in atrial fibrillation.