The
Cardiomyopathy
Association

A drug derived from foxgloves should be considered for more patients with heart failure, the Heart Failure Congress 2012 sessions of the European Society of Cardiology Heart Failure Association have been told.

Digoxin, extracted from the poisonous foxglove plant Digitalis lanata, was once standard for treating some heart problems. But in recent years its use has become more controversial, largely because studies suggested it did not help patients live longer.

But data from a 15-year-old trial, publicly released for the first time, suggests the old drug has potential for broader use in chronic heart failure,

Dr Mihai Gheorghiade, from the Northwestern University Feinberg School of Medicine in Chicago, told the meeting the study involving 6,800 patients with heart failure showed heart failure-related mortality or hospital admission fell significantly over two years for patients receiving digoxin.

He said the risk reductions were "robust" for all three high-risk subgroups in the trial: those with moderate to severe heart failure, those with a left ventricular ejection fraction (LVEF) of less than 25 per cent, or with an enlargement of the heart of over 55 per cent (over 50 per cent is considered abnormal in an adult).

The US Food and Drug Administration considered the data when it approved digoxin for heart failure in 1998, said Dr Gheorghiade, yet the findings had never before been published or presented at a meeting. But he cautioned against generalising them to contemporary practice, as all patients in the study were on ACE inhibitors and diuretics but few, if any, were on betablockers (such as bisoprolol or carvedilol) or aldosterone antagonists (such as spironolactone).

But he said: “Based on this data, I think digoxin therapy should be considered in patients who continue to have signs and symptoms in spite of available therapies. But this is not happening. There are many patients who continue to have signs and symptoms at my own institution, and digoxin is not even considered."

Prof Theresa McDonagh from King's College Hospital, London, said the study should make doctors revisit their thoughts about digoxin in heart failure, particularly in those intolerant of betablockers.

She said the drug had fallen out of favour with the broadened use of neurohormonal blocking agents, but also perhaps because the trial had showed no real difference in all-cause-mortality and so was seen as a failed trial.

She added that the guidelines still say digoxin should be considered for patients with low ejection fractions who have deteriorating symptoms despite conventional, contemporary heart-failure treatment.

Dr Piotr Ponikowski from the Medical University, Clinical Military Hospital, Wroclaw, Poland said the analysis should help revitalise interest in the drug for heart failure, he said. "I strongly believe we may need to revisit the data again in the contemporary population."