Congestive heart failure: normal sinus rhythm: digoxin reduces hospitalisation and clinical deterioration

Clinical bottom line (level 1a)

  1. Patients with congestive heart failure and a normal sinus rhythm who take digoxin compared with placebo are less likely to be admitted to hospital (NN T = 13 at 7 weeks) or have a clinical deterioration (NN T = 8 at 7 weeks) .
  2. There is no effect on mortality.
Hood et al: Cochrane Library 2001; 1 : -
Expires November 2003

The study

Systematic review of all randomised placebo-controlled trials of adult patients with congestive heart failure of
  • Patients:
  • Intervention: digoxin or digitalis compared with placebo
  • Outcome: death, hospitalisation, clinical status

    Articles found in ?all languages using Medline, Embase, Central, 1966 to June 2000 (search terms: ) and searching dissertation abstracts, annual major cardiology meeting abstracts, and references lists provided by pharmaceutical companies.

    Selection criteria: see above and below
    Appraisal criteria: reviewed by one co-author and validated by other staff - criteria used not mentioned
    Articles excluded if:
    • patients followed for less than 7 weeks
    • prevalence of AF 2% or more
    • any arrhythmia that might compromise cardiac function or any potentially reversible cause of heart failure (ischaemic heart disease or myocarditis)


    11 studies found involvign 3162 patients

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NN T
    (95% CI)
    death 7 weeks 1211/3878
    (31.2%)    		 0.99
    (0.89 to 1.09)     		460
    (NNT = 41 to infinity;
    NNH = 53 to infinity)
    hospitalisation 7 weeks 1206/3642
    (33.1%)    		 0.68
    (0.61 to 0.75)     		13
    (10 to 17)
    clinical deterioration 7 weeks 106/546
    (19.4%)    		 0.29
    (0.20 to 0.42)     		8
    (7 to 10)

    Comments

    1. Studies failed to find any difference in effect based on age, gender or duration of conegstive heart failure.

    Citation

    1. Hood WB, Dans A, Guyatt GH, et al: digitalis for treatmnet of congestive heart failure in patients in sinus rhythm (Cochrane review). Cochrane Library 2001; 1 : -
    Search Terms: digitalis in Cochrane
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient congestive heart failure and normal sinus rhythm
    Intervention or Exposure digoxin, digitalis
    Comparison placebo
    Outcome death, hospitalisation, clinical deterioration
    		•