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Rationale and design of the DIGIT‐HF trial (DIGitoxin to Improve ouTcomes in patients with advanced chronic Heart Failure): a randomized, double‐blind, placebo‐controlled study
Author(s) -
Bavendiek Udo,
Berliner Dominik,
Dávila Lukas Aguirre,
Schwab Johannes,
Maier Lars,
Philipp Sebastian A.,
Rieth Andreas,
Westenfeld Ralf,
Piorkowski Christopher,
Weber Kristina,
Hänselmann Anja,
Oldhafer Maximiliane,
Schallhorn Sven,
von der Leyen Heiko,
Schröder Christoph,
Veltmann Christian,
Störk Stefan,
Böhm Michael,
Koch Armin,
Bauersachs Johann
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1452
Subject(s) - medicine , heart failure , ejection fraction , digitoxin , cardiology , atrial fibrillation , randomized controlled trial , placebo , randomization , clinical endpoint , digoxin , alternative medicine , pathology
Aims Despite recent advances in the treatment of chronic heart failure (HF), mortality and hospitalizations still remain high. Additional therapies to improve mortality and morbidity are urgently needed. The efficacy of cardiac glycosides – although regularly used for HF treatment – remains unclear. DIGIT‐HF was designed to demonstrate that digitoxin on top of standard of care treatment improves mortality and morbidity in patients with HF and a reduced ejection fraction (HFrEF). Methods Patients with chronic HF, New York Heart Association (NYHA) functional class III–IV and left ventricular ejection fraction (LVEF) ≤ 40%, or patients in NYHA functional class II and LVEF ≤ 30% are randomized 1:1 in a double‐blind fashion to treatment with digitoxin (target serum concentration 8–18 ng/mL) or matching placebo. Randomization is stratified by centre, sex, NYHA functional class (II, III, or IV), atrial fibrillation, and treatment with cardiac glycosides at baseline. A total of 2190 eligible patients will be included in this clinical trial (1095 per group). All patients receive standard of care treatment recommended by expert guidelines upon discretion of the treating physician. The primary outcome is a composite of all‐cause mortality or hospital admission for worsening HF (whatever occurs first). Key secondary endpoints are all‐cause mortality, hospital admission for worsening HF, and recurrent hospital admission for worsening HF. Conclusion The DIGIT‐HF trial will provide important evidence, whether the cardiac glycoside digitoxin reduces the risk for all‐cause mortality and/or hospital admission for worsening HF in patients with advanced chronic HFrEF on top of standard of care treatment.