Digitoxin in Patients with Heart Failure and Reduced Ejection Fraction

To the Editor: The DIGIT-HF (Digitoxin to Improve Outcomes in Patients with Advanced Chronic Heart Failure) trial, conducted by Bavendiek et al. (Sept. 25 issue), 1 showed the superiority of digitoxin plus guideline-directed medical therapy over placebo plus guideline-directed medical therapy for the primary outcome (composite of death from any cause or hospital admission for worsening heart failure). However, the primary-outcome curves for the digitoxin and placebo groups reconverged, which suggests that the benefit observed at a median follow-up of 36 months may not be sustained. 2 Does prolonged therapy with digitoxin result in neutral or detrimental effects? In addition, subgroup analyses . . .