Digoxin withdrawal in patients with sinus rhythm and previous heart failure resulted in clinical deterioration in 22.7% of patients compared to 13.6% on digoxin (not statistically significant).
RCT (n=22)
Double-blind
Crossover
Does digoxin withdrawal cause clinical deterioration in patients with sinus rhythm and a previous history of frank heart failure?
Digoxin withdrawal in patients with sinus rhythm and prior heart failure did not lead to statistically significant clinical deterioration, suggesting maintenance therapy may not provide clinical benefit to the majority of these patients despite sustained inotropic effects.
Absolute Event Rate: 22.7% vs 13.6%
p-value: p=NS
A double-blind placebo-controlled crossover trial of digoxin withdrawal was undertaken in 22 patients with sinus rhythm who had a previous history of frank heart failure and were taking therapeutic doses of the drug. During the course of the study, 14 patients showed no clinical change whether taking digoxin or placebo, five patients deteriorated on placebo (four with heart failure and one with supraventricular tachycardia), and three on digoxin (two with heart failure and one with digoxin toxicity). These differences were not statistically significant. Compared to placebo, patients, while taking digoxin, had lower resting heart rates and significant shortening of all the systolic time intervals. The drug appears to exert a sustained positive inotropic effect during maintenance therapy, but this is not of clinical benefit to the majority of patients.
Taggart et al. (Tue,) conducted a rct in Heart failure with sinus rhythm (n=22). Digoxin withdrawal (placebo) vs. Digoxin continuation was evaluated on Clinical deterioration (p=NS). Digoxin withdrawal in patients with sinus rhythm and previous heart failure resulted in clinical deterioration in 22.7% of patients compared to 13.6% on digoxin (not statistically significant).
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