# Meta-analyse DECISION + DIGIT-HF + DIG: digitalisglycosiden reduceren verslechterende hartfalenevents over 9.013 patiënten

*geplaatst 2026-05-10 · Hartfalen · European Heart Journal · doi 10.1093/eurheartj/ehag387 · https://hartvaat.nl/2026/05/09/meta-analyse-decision-digit-hf-dig-digitalisglycosiden-reduceren-verslechterende/*

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.

## English: 

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.

## Abstract (original, from the publication)

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.

Auteurs: Ragnhild Helseth, Ryohei Ono, Brian Claggett, Yasuhiro Hamatani, Mihaly Ruppert, Akshay Desai, Scott D Solomon

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Bron: European Heart Journal, https://doi.org/10.1093/eurheartj/ehag387. Bijgewerkt 2026-07-03T18:39:32Z. 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.