Low-dose digoxin, a heart drug derived from the foxglove plant that costs less than 10 cents a day, was linked to about 25% fewer worsening heart failure events in a new meta-analysis of three randomized trials totaling 9,013 patients. The pooled results were presented at the ESC Heart Failure Congress in Barcelona on 10 May 2026.
The analysis combined the DECISION, DIGIT-HF and DIG trials. Adding digoxin, or the related drug digitoxin, was tied to a 15% reduction in the combined risk of cardiovascular death or a first worsening heart failure event (hazard ratio 0.85). The benefit was driven by worsening heart failure events, a composite of hospitalizations and urgent hospital visits, which fell by roughly a quarter (hazard ratio 0.75). Cardiovascular mortality was unchanged (hazard ratio 0.99).
Why an old drug fell out of favor
Digoxin has been used in cardiovascular medicine for centuries. Preparations from the foxglove plant were among the first medicines given for a failing heart, and digoxin remains the oldest drug still in cardiac use.
Its role narrowed as newer therapies arrived. "With the introduction of foundational therapies in the past decade, digitalis glycosides were no longer considered first-line heart failure treatment," said Kevin Damman, MD, PhD, medical director of the heart transplant and ventricular assist device program at University Medical Centre Groningen.
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About 15% to 20% of heart failure patients still receive digoxin today, and generic tablets cost under 10 cents a day.
What the trials tested
The centerpiece of the pooled analysis was DECISION, a Dutch double-blind trial of 1,001 patients with symptomatic chronic heart failure and a left ventricular ejection fraction of 50% or less. Participants had a mean age of 73, and 28% were women. Half received low-dose digoxin on top of standard therapy for a median of 36.5 months, the other half a placebo.
On its own, DECISION did not reach statistical significance for its primary endpoint. Pooled with the DIGIT-HF trial of digitoxin, published in 2025, and the historic 1997 DIG trial, the benefit for worsening heart failure emerged clearly and consistently.
"Digoxin is the oldest drug in cardiovascular medicine, but there has been uncertainty about its value," said Dirk van Veldhuisen, principal investigator of DECISION at University Medical Centre Groningen. He called low-dose digitalis glycosides "an effective additional medical treatment option, which are cheap, safe and easy to use."
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What it means for patients
The meta-analysis suggests low-dose digoxin can be added to modern heart failure therapy to reduce worsening events, though it did not extend life on its own. Digoxin has a narrow therapeutic window and can interact with other heart medicines, so dosing must be tailored to blood levels and kidney function.
Anyone living with heart failure should talk with their cardiologist before starting, changing or stopping any medication, including digoxin.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.