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DIG (Digitalis Investigation Group)
DIG (Digitalis Investigation Group)M Gheorghiade (Northwestern University Feinberg School of Medicine, Chicago, IL)Heart F...
DIG: Results• >1/2 of patients with systolic HF randomized fell into three high-risk subgroups,  and in all three, HF-rela...
DIG: Commentary*"Based on this data, and this is consistent with the guidelines, I think digoxintherapy should be consider...
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DIG (Digitalis Investigation Group)

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http://www.theheart.org/web_slides/1425503.do

A randomized, double-blind, simple, multicenter study to determine if digoxin had a beneficial, harmful, or no effect on total mortality in patients with clinical heart failure and sinus rhythm

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DIG (Digitalis Investigation Group)

  1. 1. DIG (Digitalis Investigation Group)
  2. 2. DIG (Digitalis Investigation Group)M Gheorghiade (Northwestern University Feinberg School of Medicine, Chicago, IL)Heart Failure Congress 2012• A randomized, double-blind, simple, multicenter study to determine if digoxin had a beneficial, harmful, or no effect on total mortality in patients with clinical heart failure and sinus rhythm• Population and treatment: In the main trial, patients with LVEF of 0.45 or less were randomly assigned to digoxin (3397 patients) or placebo (3403 patients) in addition to diuretics and ACE inhibitors In an ancillary trial of patients with ejection fractions greater than 0.45, 492 patients were randomly assigned to digoxin and 496 to placebo• Primary outcome: All-cause mortality LVEF=left ventricular ejection fractions
  3. 3. DIG: Results• >1/2 of patients with systolic HF randomized fell into three high-risk subgroups, and in all three, HF-related mortality or hospitalization fell significantly over two years with digoxin• Composite of all-cause mortality or hospitalization also declined significantly but less sharply—mortality didnt figure much in either of the two benefits, driven primarily by fewer hospitalizations with digoxinDIG prespecified high-risk-subgroup analysis: Hazard ratios(95% CI), p, for composite end points that includehospitalization End point NYHA 3-4, n=2223 LVEF<25%, n=2256 CTR >55%, n=2345 Any of the 3 high-risk features, n=4367All-cause mortality or hospitalization 0.88 (0.80–0.97); 0.84 (0.76–0.93); 0.85 (0.77–0.94); 0.87 (0.81–0.94); p=0.012 p=0.001 p=0.002 p<0.001Heart-failure-related mortality or 0.65 (0.57–0.75); 0.61 (0.53–0.71); 0.65 (0.57–0.75); 0.66 (0.59–0.73);hospitalization p<0.001 p<0.001 p<0.001 p<0.001 HF=heart failure CTR=cardiothoracic ratio
  4. 4. DIG: Commentary*"Based on this data, and this is consistent with the guidelines, I think digoxintherapy should be considered in patients who continue to have signs and symptomsin spite of available therapies. But this is not happening. There are many patientswho continue to have signs and symptoms at my own institution, and digoxin is noteven considered." - Dr Mihai Gheorghiade"Maybe we should also have it in our minds for those intolerant of beta blockade." - Prof Theresa A McDonagh"I strongly believe we may need to revisit the data again in the contemporarypopulation." - Dr Piotr Ponikowski *All comments from DIG revisited: Digoxin scrutinized anew for chronic heart failure (http://www.theheart.org/article/1404951.do)
  5. 5. Become a member of http://www.theheart.org Become a fan on Facebook: http://www.facebook.com/theheartorg Follow us on Twitter: http://www.twitter.com/theheartorgtheheart.org is the leading online source of independent cardiology news.We are the top provider of news and opinions for over 100 000 physicians.

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