Digoxin Improves Heart Failure Outcomes in Patients with Rheumatic Heart Disease
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on June 12th, 2026
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Rheumatic heart disease remains a major public health challenge in many low- and middle-income countries, particularly among young and middle-aged adults. The condition is a leading cause of heart failure and contributes substantially to cardiovascular mortality. Digoxin has long been used in the management of heart failure and atrial fibrillation, prompting researchers to investigate its role in patients with rheumatic heart disease. A recent study published in the Journal of the American Medical Association evaluated the effectiveness of digoxin in this population.
Funding Source(s): Indian Council of Medical Research
The clinical trial was conducted in India and enrolled 1,769 participants with a mean age of 46 years. All participants had rheumatic heart disease confirmed by echocardiography. Atrial fibrillation was present in approximately 70% of patients, and nearly 80% were classified as New York Heart Association (NYHA) class II, indicating mild heart failure with slight limitation of physical activity but preserved ability to perform routine daily tasks.
Participants were randomly assigned to receive either placebo or digoxin at a daily dose of 0.25 mg. After two years of follow-up, patients treated with digoxin experienced an 18% lower risk of worsening heart failure compared with those receiving placebo. In addition, digoxin reduced the risk of death attributable to heart failure by 25%. Subgroup analyses suggested that the greatest benefit was observed among older patients, those with atrial fibrillation, individuals with lower body mass index, and those with better renal function. The researchers noted that future studies should evaluate the effectiveness of digoxin in older populations with additional comorbidities, including atherosclerotic cardiovascular disease and chronic kidney disease, to better define its role in contemporary heart failure management.
Funding Source(s): Indian Council of Medical Research
The clinical trial was conducted in India and enrolled 1,769 participants with a mean age of 46 years. All participants had rheumatic heart disease confirmed by echocardiography. Atrial fibrillation was present in approximately 70% of patients, and nearly 80% were classified as New York Heart Association (NYHA) class II, indicating mild heart failure with slight limitation of physical activity but preserved ability to perform routine daily tasks.
Participants were randomly assigned to receive either placebo or digoxin at a daily dose of 0.25 mg. After two years of follow-up, patients treated with digoxin experienced an 18% lower risk of worsening heart failure compared with those receiving placebo. In addition, digoxin reduced the risk of death attributable to heart failure by 25%. Subgroup analyses suggested that the greatest benefit was observed among older patients, those with atrial fibrillation, individuals with lower body mass index, and those with better renal function. The researchers noted that future studies should evaluate the effectiveness of digoxin in older populations with additional comorbidities, including atherosclerotic cardiovascular disease and chronic kidney disease, to better define its role in contemporary heart failure management.