A very old and inexpensive heart medicine may still have an important role in modern heart failure treatment, according to new research from the University Medical Center Groningen.
Researchers say a low dose of the drug digoxin could help reduce hospital admissions and possibly lower deaths in people with heart failure.
The findings come from three studies led by cardiologists Dirk Jan van Veldhuisen, Kevin Damman, and Peter van der Meer. The results were published in major medical journals including Nature Medicine and JAMA and were also presented at the ESC Heart Failure Congress in Barcelona.
Heart failure is a serious long-term condition that affects millions of people worldwide. In the Netherlands alone, more than 500,000 people are believed to live with the disease, and experts expect this number to rise as the population ages.
Heart failure does not mean the heart completely stops working. Instead, it means the heart becomes too weak or too stiff to pump blood properly throughout the body. As a result, organs and tissues may not receive enough oxygen and nutrients.
People with heart failure often feel tired and weak. Many also experience shortness of breath, swelling in the legs, difficulty exercising, and repeated hospital visits when symptoms suddenly worsen.
Doctors currently treat heart failure using a combination of medicines often called the “Fantastic Four.” These medications help reduce strain on the heart, improve blood flow, and lower the risk of hospitalization and death.
For many years, scientists have wondered whether digoxin could provide additional benefits when added to these standard medications.
Digoxin, also known as digitalis, is one of the oldest medicines used for heart disease. It has been prescribed for centuries and originally came from the foxglove plant. In the past, doctors often used higher doses of the drug to make the heart pump more strongly.
However, high doses sometimes caused dangerous side effects, including abnormal heart rhythms. Over time, the use of digoxin declined as newer heart failure drugs became available.
Researchers later realized that lower doses of digoxin may work differently and more safely.
Instead of forcing the heart to contract harder, low-dose digoxin appears to reduce harmful stress responses inside the body. It lowers levels of stress hormones such as adrenaline, which can otherwise place extra strain on a weakened heart.
The new research tested whether adding low-dose digoxin to modern heart failure treatment could still improve outcomes.
The main study involved about 1,000 heart failure patients treated across 43 medical centers in the Netherlands. Half of the patients received low-dose digoxin in addition to their usual treatment, while the other half received a placebo.
Patients were followed for an average of three years.
Researchers found that digoxin reduced the combined risk of worsening heart failure and death from cardiovascular disease by about 19%. Although this reduction alone did not reach statistical significance in the first study, researchers then combined the results with two earlier studies in a larger meta-analysis.
By analyzing data from a much larger group of patients, scientists confirmed that low-dose digoxin provided important and statistically significant benefits.
One of the biggest findings was a roughly 25% reduction in hospital admissions for heart failure.
Researchers also found that the low-dose treatment appeared safe and easy for patients to use.
In another part of the research, scientists followed around 600 patients who had either received digoxin or placebo. They discovered that patients who stopped taking digoxin after previously receiving it experienced more health problems during the first six weeks after stopping the drug.
Among 288 patients who stopped digoxin, 14 were hospitalized or died during this short period.
Researchers said the findings were surprisingly strong and suggested the medication may indeed provide meaningful protection for patients with heart failure.
The studies are important because digoxin is extremely inexpensive compared with many newer heart failure medications. Researchers estimated the drug costs less than ten cents per day, while some modern medications cost several euros daily.
Currently, only about 15% of heart failure patients receive digoxin treatment. Researchers believe these new findings may eventually influence future heart failure guidelines and lead to wider use of low-dose digoxin.
Still, scientists caution that doctors must continue using the medicine carefully. Digoxin has a narrow safety range, meaning the correct dose is important.
Researchers also emphasize that the newer studies focused specifically on low-dose treatment, not the higher doses that were more common decades ago.
The findings suggest that old medicines may still hold important value when used in new ways. As healthcare systems around the world face rising costs, affordable drugs that reduce hospitalizations could become increasingly important.
The study also highlights how understanding of medications can change over time. A drug once considered outdated may still provide important benefits when researchers better understand how to use it safely.
Although more research may still be needed, the new findings suggest low-dose digoxin could become a valuable fifth treatment added to standard heart failure therapy for some patients.
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Source: University Medical Center Groningen.
