GRONINGEN, NETHERLANDS / EuroWire / — Low dose digoxin, a medicine derived from digitalis and used in cardiology for more than two centuries, has returned to the center of heart failure research after new Dutch and international studies reported fewer worsening heart failure events among patients receiving digitalis glycosides. The findings focus on patients with heart failure with reduced or mildly reduced ejection fraction, a group at elevated risk of hospital treatment, urgent care visits and cardiovascular death.
The DECISION trial, led by University Medical Center Groningen cardiologists, enrolled 1,001 patients with symptomatic chronic heart failure at 43 sites in the Netherlands. Participants had a left ventricular ejection fraction of 50 percent or lower and were randomly assigned to receive low dose digoxin or placebo in addition to standard care. The trial used blood monitoring to target serum digoxin concentrations of 0.5 to 0.9 nanograms per milliliter.
In DECISION, the primary composite endpoint included total worsening heart failure events and cardiovascular mortality. The trial recorded fewer events in the digoxin group than in the placebo group, but the result did not reach statistical significance. Cardiovascular mortality was similar between groups. The study population had a mean age of about 72 years, included women and men, and included patients with atrial fibrillation as well as sinus rhythm.
Combined evidence strengthens findings
A separate meta analysis published in JAMA combined data from three large placebo controlled trials of digitalis glycosides involving 9,013 participants. The pooled analysis found digitalis glycoside treatment was associated with a lower risk of cardiovascular death or first worsening heart failure event, mainly because of fewer worsening heart failure events. The analysis did not show a reduction in all cause mortality or cardiovascular death when those outcomes were assessed separately.
The University Medical Center Groningen researchers also highlighted the cost of digoxin, which is widely available as a generic medicine and can cost less than 10 cents per day in some settings. That price has drawn attention because heart failure care commonly involves multiple medicines taken long term. The studies assessed digoxin as an add on therapy rather than as a replacement for established guideline directed treatments.
Safety findings define current evidence
The European Society of Cardiology presented the findings at Heart Failure 2026, where researchers discussed the DECISION trial, the pooled analysis and related evidence on digitalis glycosides. Low dose digoxin was generally well tolerated in DECISION under monitored serum concentration targets. The trial also included analyses of treatment discontinuation, which recorded more cardiovascular death or worsening heart failure events after withdrawal of digoxin than after withdrawal of placebo.
The evidence places an inexpensive older medicine back into contemporary heart failure debate while preserving important limits from the data. DECISION did not meet statistical significance for its primary endpoint, and the larger pooled evidence showed benefit driven by fewer worsening heart failure events rather than by lower mortality. The findings describe measurable outcomes in defined patient groups, supported by randomized trial data, dosing controls and modern background heart failure therapy.