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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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30. Cardiovascular Disease in Special Populations
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32. Cardiovascular Nursing
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Real-World Patterns of Digoxin Use and Safety in Heart Failure: Insights from a Contemporary Ambulatory Cohort
Session:
Sessão de Posters 11 - Dos digitálicos aos diuréticos no espectro da insuficiência cardíaca
Speaker:
Francisco Salvaterra
Congress:
CPC 2026
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Francisco Salvaterra; Diogo Ferreira; Ana Francês; Fátima Salazar; Nuno Lousada; Joana Rigueira; Rafael Santos; Doroteia Silva; Fausto J. Pinto; Dulce Brito; João Agostinho
Abstract
<p><strong>Introduction </strong></p> <p>Digoxin use in HF has declined due to safety concerns and limited recent evidence, but the DIGIT-HF trial renewed interest in digitalic’s role, particularly for more advanced HF patients. Updated real-world data on its use and safety are therefore needed.</p> <p><strong>Aim</strong><br /> To characterize real-world prescribing patterns, indications, monitoring, and safety outcomes of digoxin in patients with HF.</p> <p><strong>Methods</strong><br /> We conducted a retrospective observational study of HF patients on digoxin, collecting demographic, clinical, echocardiographic, therapeutic, and follow-up data, including initiation indications and serum digoxin levels.<br /> </p> <p><strong>Results</strong><br /> In a population of 900 patients, a total of 59 patients were treated with digoxin and were included, with a mean age of 69.8 ± 11.6 years, BMI of 28.3 ± 8.46 kg/m² and advanced systolic dysfunction (mean LVEF 32.6%). Baseline heart rate averaged 75.7 ± 15.4 bpm and mean systolic/diastolic blood pressures were 115.9 ± 20.3 and 69.1 ± 12.4 mmHg. Biomarker and renal profiles reflected significant disease burden, with a median NT-proBNP of 2134 pg/mL (IQR 1017–3595), mean creatinine, 1.20 ± 0.36 mg/dL, and estimated GFR, 57.6 ± 21.0 mL/min/1.73m²; chronic kidney disease was present in 30.5%. Atrial arrhythmias were highly prevalent, with atrial fibrillation in 84.8% of patients and atrial flutter in 5.1%. 10.1% of patients were in sinus rhythm. Most patients<br /> had HFrEF (72.9%). Digoxin was mainly prescribed for atrial arrhythmia–related rate control, accounting for almost 90% of indications. Only 10.3% received digoxin primarily for HFrEF management independent of rhythm or need for rate control. Serum digoxin was measured in 34 patients (52 assays). Therapeutic levels (0.5–0.9 ng/mL) were observed in 11 patients, while 10 had levels &gt;0.9 ng/mL, although only one reached a toxic level (&gt;2 ng/mL) in the context of renal function worsening. In 13 patients, concentrations remained &lt;0.5 ng/mL, reflecting adequate rate control achieved with lower digoxin doses rather than subtherapeutic exposure. No adverse events attributed to digoxin were recorded. Digoxin was discontinued in 7 patients (11.9%), because its maintenance was deemed unnecessary (4 patients), either because the target heart rate was attained independent of digoxin use or<br /> because a rhythm-control strategy was implemented or due to renal function decline, levels above the safety margin or iatrogenic concerns (1 patient each). Outcomes after withdrawal were favorable, with only one HF hospitalization recorded.</p> <p><br /> <strong>Conclusions</strong><br /> In this real-world cohort, digoxin was used mainly for atrial arrhythmia rate control. Target digoxin levels were achieved in most patients, reflecting ease of use and contributing to the low rate of adverse events, even after discontinuation. These findings suggest that digoxin may warrant broader reconsideration as a therapeutic option in selected patients with HFrEF.</p>
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