{"id":"38bf364941b5","type":"article","url":"https://hartvaat.nl/2026/05/09/meta-analyse-decision-digit-hf-dig-digitalisglycosiden-reduceren-verslechterende/","title":"Meta-analyse DECISION + DIGIT-HF + DIG: digitalisglycosiden reduceren verslechterende hartfalenevents over 9.013 patiënten","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","dapa-hf","heart-failure-2026","lipidenverlaging","soul-trial","statines"],"journal":"European Heart Journal","doi":"10.1093/eurheartj/ehag387","source_url":"https://doi.org/10.1093/eurheartj/ehag387","authors":["Ragnhild Helseth","Ryohei Ono","Brian Claggett","Yasuhiro Hamatani","Mihaly Ruppert","Akshay Desai","Scott D Solomon"],"significance":8,"published":"2026-05-10","source_date":"2026-05-09","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"heart-failure-2026","summary_en":"A study-level meta-analysis pooling DECISION, DIGIT-HF and DIG (n=9,013) shows digitalis glycosides reduce CV death or first worsening HF event (HR 0.85; 95% CI 0.80–0.90; p<0.001) and time to first worsening HF event (HR 0.75; p<0.001), with consistent benefit on top of contemporary RALES/EMPHASIS-HF/PARADIGM-HF/DAPA-HF backbones. Population-level evidence reopening the case for digitalis as an add-on in symptomatic HF(m)rEF despite four-pillar therapy.","created":"2026-07-03T10:32:53Z","updated":"2026-07-03T18:39:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie-niveau meta-analyse die DECISION (n=1.001), DIGIT-HF (~1.240) en DIG (n=6.800) combineert tot 9.013 patiënten met HF(m)rEF gerandomiseerd naar digoxine, digitoxine of placebo. Digitalisglycosiden verlaagden het samengestelde primaire eindpunt — cardiovasculaire sterfte of eerste verslechterende hartfalenevent — significant (HR 0,85; 95% BI 0,80–0,90; p<0,001). Tijd tot eerste verslechterende hartfalenevent was 25% lager (HR 0,75; 95% BI 0,69–0,81; p<0,001). De winst bleef behouden bij patiënten op moderne richtlijntherapie (RALES, EMPHASIS-HF, PARADIGM-HF en DAPA-HF rugbones), zonder heterogeniteit tussen trials of glycosidetypen. Conclusie: op populatieniveau verminderen digitalisglycosiden hartfalenverslechtering bovenop hedendaagse GDMT. Pleidooi voor herwaardering van een goedkope, oude pijler in geselecteerde patiënten — vooral bij persistent symptomatische HF ondanks vier-pillartherapie.","abstract_original":"Background: Whether digitalis glycosides retain a role in heart failure with reduced or mildly reduced ejection fraction (HF(m)rEF) on top of contemporary guideline-directed medical therapy is debated. Methods: This study-level meta-analysis combined the DECISION (n=1001), DIGIT-HF (~1240) and DIG (n=6800) trials, totalling 9013 patients with HF(m)rEF assigned to digoxin, digitoxin or placebo. The primary outcome was a composite of cardiovascular death or first worsening heart failure event. Secondary analyses examined time to first worsening heart failure event and pre-specified interaction with guideline-recommended medical therapy use across the RALES, EMPHASIS-HF, PARADIGM-HF and DAPA-HF backbones. Results: Compared with placebo, digitalis glycosides significantly reduced the primary composite (HR 0.85; 95% CI 0.80–0.90; p<0.001) and the time to first worsening heart failure event (HR 0.75; 95% CI 0.69–0.81; p<0.001). The benefit was consistent across trials and was maintained in patients already on contemporary guideline-recommended HF therapy, with no heterogeneity by trial type or glycoside variant. Conclusions: At the population level, digitalis glycosides reduce worsening heart failure events on top of contemporary guideline-directed therapy, supporting reconsideration of their place in HF(m)rEF treatment."}