{"id":"d5baa45bf758","type":"article","url":"https://hartvaat.nl/2026/05/10/decision-trial-digoxine-staken-bij-hartfalen-leidt-tot-zevenvoudige-stijging-in-/","title":"DECISION-trial: digoxine staken bij hartfalen leidt tot zevenvoudige stijging in HF-events binnen 6 weken","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["dapa-hf","pathfinder-trial"],"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","Henk P Swart","H Jaco Houtgraaf","H G Reinhart Dorman","Michiel Rienstra","Kevin Damman","Arend Mosterd"],"significance":8,"published":"2026-06-25","source_date":"2026-05-10","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/obstructief-slaapapneu-en-hart/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"Prespecified analysis of the DECISION trial: 1,001 heart failure patients on contemporary guideline therapy were randomised to low-dose digoxin or placebo, with a median treatment of 36.5 months. At study end, 587 patients on active treatment (288 digoxin, 299 placebo) underwent blinded withdrawal with 6-week follow-up. During the 100 days before withdrawal, cardiovascular death/HF event rates were similar (5.7 vs 6.5 events per 100 patient-years). After withdrawal, the rate rose sharply in the digoxin arm but not in the placebo arm (42.8 vs 5.9 per 100 patient-years; time-by-treatment interaction p=0.036). 14 events occurred in the digoxin withdrawal arm (12 hospitalisations, 2 urgent HF visits) versus 2 in the placebo withdrawal arm (RR 7.37; 95% CI 1.56-34.88; p=0.012). Withdrawal was accompanied by higher heart rate, lower systolic BP, and rising NT-proBNP. Conclusion: caution is warranted when stopping long-standing digoxin in HF with (mildly) reduced ejection fraction.","created":"2026-07-03T10:33:07Z","updated":"2026-07-03T18:39:36Z","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":"Voorafgespecificeerde analyse van de DECISION-trial: 1.001 hartfalen-patiënten op moderne richtlijntherapie werden gerandomiseerd tussen laaggedoseerd digoxine en placebo, met mediaan 36,5 maanden behandeling. Aan het einde ondergingen 587 patiënten op actieve behandeling (288 digoxine, 299 placebo) een geblindeerde stoppoging, met follow-up na 6 weken. Tijdens de 100 dagen vóór het staken waren de cardiovasculaire sterfte/HF-events vergelijkbaar (5,7 versus 6,5 events per 100 patiëntjaren). Na staken steeg de event-incidentie sterk in de digoxine-arm maar niet in de placebo-arm (42,8 versus 5,9 per 100 patiëntjaren; tijds-behandelinteractie p=0,036). 14 events in de digoxine-stop-arm (12 opnames, 2 spoed-HF-bezoeken) versus 2 in de placebo-stop-arm (RR 7,37; 95%-BI 1,56-34,88; p=0,012). Staken ging gepaard met hogere hartfrequentie, lagere systolische bloeddruk en stijgend NT-proBNP. Conclusie: voorzichtigheid bij het staken van langdurig gebruikte digoxine bij HF met (mildly) verminderde ejectiefractie.","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."}