A medicine older than modern cardiology itself — and cheaper than a stick of gum — may be making a comeback. Three studies led by cardiologists at the University Medical Center Groningen (UMCG) in the Netherlands suggest that low-dose digoxin can keep heart-failure patients out of the hospital. The findings appeared in Nature Medicine and JAMA and were presented at the ESC Heart Failure Congress in Barcelona.
In the main trial, 1,000 heart-failure patients treated at 43 Dutch centers received either a low dose of digoxin or a placebo, on top of their usual care, for an average of three years. On its own, the trial found a 19% reduction in cardiovascular deaths and worsening heart failure — an effect that did not reach statistical significance.
But when the team pooled the data with two earlier studies in a meta-analysis, the picture sharpened: hospital admissions for heart failure fell by an average of 25%, a statistically significant benefit that held even for patients already taking the standard four-drug 'Fantastic Four' regimen. Low-dose digoxin also proved safe and easy to use.
A third study underlined the drug's potency in an unexpected way: of 288 patients who stopped taking digoxin after the trial ended, 14 were hospitalized or died within the first six weeks — a rebound effect the researchers called impressive and surprising.
Digoxin costs less than 10 cents a day, a fraction of the price of newer heart-failure drugs. It fell out of favor after high doses proved harmful, and only about 15% of patients receive it today. At low doses, the drug works by dampening stress hormones such as adrenaline rather than forcing a weakened heart to work harder — the mechanism that made older, higher doses counterproductive.
The research, funded with €3 million from the Dutch Heart Foundation (Hartstichting), could now influence treatment guidelines and make an ultra-cheap, centuries-old drug available to far more of the millions of people living with heart failure.
