{"id":"42af12d46da0","type":"article","url":"https://hartvaat.nl/2026/05/10/decision-onttrekkingssubstudie-stoppen-van-digoxine-na-lange-behandeling-leidt-t/","title":"DECISION-onttrekkingssubstudie: stoppen van digoxine na lange behandeling leidt tot acute verslechtering","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anticoagulantia","aspirine","bloeddrukbehandeling","dubbele-trombocytenremming","farmaco-economie","heart-failure-2026"],"journal":"European Heart Journal","doi":"10.1093/eurheartj/ehag385","source_url":"https://doi.org/10.1093/eurheartj/ehag385","authors":["Peter van der Meer","Dirk J van Veldhuisen","Geert H D Voordes","Jan Tijssen","Marco Alings","M L Bouvy"],"significance":8,"published":"2026-05-10","source_date":"2026-05-10","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/nhg-standaard-hartfalen-2021/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"heart-failure-2026","summary_en":"Pre-specified DECISION substudy: 587 patients on active treatment (digoxin or placebo) underwent blinded withdrawal with 6-week in-person follow-up. Pre-withdrawal event rates were similar between groups. Post-withdrawal, digoxin-withdrawn patients had a sharp increase in CV death/worsening HF events (42.8 vs 5.9 per 100 patient-years; RR 7.37; 95% CI 1.56–34.88; p=0.012), accompanied by rising heart rate, falling SBP and rising NT-proBNP. Discontinuing digoxin after long-term exposure is associated with clinical deterioration — a clinically relevant caution for deprescribing reviews.","created":"2026-07-03T10:32:53Z","updated":"2026-07-03T13:31:49Z","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":"Vooraf gespecificeerde subanalyse van de DECISION-trial: 587 patiënten die op actieve behandeling stonden (288 digoxine, 299 placebo) ondergingen aan het einde van de studie blinde onttrekking met follow-up na zes weken. Vóór onttrekking waren CV-sterfte- en verslechterende hartfalenrate 5,7 versus 6,5 events per 100 patiëntjaren (rate ratio 0,88). Ná onttrekking schoot de rate omhoog in de digoxine-onttrekkingsarm — 42,8 vs 5,9 events per 100 patiëntjaren (interactie p=0,036). Veertien events (12 ziekenhuisopnames, 2 urgente bezoeken) traden op in de digoxine-onttrekkingsarm versus twee in de placeboarm (RR 7,37; 95% BI 1,56–34,88; p=0,012). Onttrekking ging gepaard met stijging van hartfrequentie (p=0,003), daling van systolische bloeddruk (p=0,014) en stijging van NT-proBNP (p=0,002). Conclusie: digoxine niet zomaar stoppen. Wie chronisch op lage-dosis digoxine staat heeft ondersteuning aan het middel, ook als gerichte richtlijnstart van novo niet duidelijk superieur is. Klinisch belangrijke waarschuwing voor afbouw bij polyfarmacie-evaluaties.","abstract_original":"Background and aims: Whether digoxin withdrawal is safe in patients with heart failure (HF) optimized on contemporary guideline-recommended medical therapy remains unknown. This prespecified analysis of the DECISION trial evaluated outcomes following blinded withdrawal of digoxin or placebo. Methods: In DECISION, 1001 patients were randomized to low-dose digoxin or placebo and treated for a median of 36.5 months. At the end of the study, 587 patients on active treatment (digoxin 288, placebo 299) underwent blinded withdrawal with an in-person follow-up visit at six weeks. All events were adjudicated. Results: During the pre-withdrawal phase (100 days), incidence rates of cardiovascular (CV) death or worsening HF events were 5.7 versus 6.5 events per 100 patient-years in the digoxin versus placebo group; rate ratio 0.88 (95%CI 0.24-3.10). Following withdrawal, the incidence rate increased markedly in patients withdrawn from digoxin but not placebo (42.8 vs. 5.9 events per 100 patient-years; time period-by-treatment interaction, P=0.036). Fourteen events (12 hospitalizations and 2 urgent HF visits) occurred in the digoxin withdrawal arm versus two (one HF hospitalization and one CV death) in the placebo withdrawal arm (RR 7.37, 95% CI 1.56–34.88; P=0.012). Withdrawal of digoxin was accompanied by an increase in heart rate (p=0.003), reduction in systolic blood pressure (p=0.014) and rise in NT-proBNP (p=0.002). Conclusions: Discontinuation of digoxin after long-term treatment is associated with clinical deterioration in patients with HF and a reduced or mildly reduced ejection fraction. These findings warrant caution when stopping digoxin."}