HFA 2026: Digitalis Glycosides in HF — DECISION/DIGIT-HF/DIG Meta-Analysis

HFA Congress 2026 - Dr Kevin Damman (University Medical Centre Groningen, Groningen, NL) joins us to discuss findings from a study-level meta-analysis combining data from the DECISION, DIGIT-HF and DIG trials to evaluate the role of digitalis glycosides (digoxin and digitoxin) in heart failure with reduced and mildly reduced ejection fraction. This analysis brings together evidence from three major randomised trials encompassing 9,000 patients to provide a contemporary and comprehensive assessment of low-dose digitalis therapy - one of the oldest agents in cardiovascular medicine - when added to modern guideline-directed medical therapy. By pooling trial-level data, the analysis aims to clarify the net clinical benefit, safety profile, and role of digitalis as potential fifth pillar therapy in heart failure management. Findings showed a 15% relative risk reduction in the composite endpoint of cardiovascular death or first worsening heart failure event, driven primarily by a 25% reduction in heart failure events. Dr Damman discusses the implications for clinical practice, cost-effectiveness considerations, and potential integration into upcoming ESC guideline updates. Interview Questions: 1. How do you characterise digitalis glycosides in contemporary HF management, and what prompted this meta-analysis? 2. What was the rationale for combining the DECISION, DIGIT-HF and DIG trials specifically, and what does pooling these datasets allow you to assess that individual trials could not? 3. What were your key findings? 4. Were there particular patient subgroups that appeared to derive greater or lesser benefit from digitalis glycosides, and how might this inform patient selection in practice? 5. How do these findings sit alongside current heart failure guidelines, and do you think they warrant any revision to recommendations arounddigitalis glycosides use? 6. Where does this leave digitoxin in heart failure management — is there a clearly defined future role, and what further evidence would help establish it? Recorded on-site at Heart Failure Association Congress 2026, Barcelona. Editors: Jordan Rance, Mirjam Boros Videographer: David Ben-Harosh, Tom Green Support: This is an independent interview produced by Radcliffe Cardiology. Visit Radcliffe Cardiology: https://www.radcliffecardiology.com/ This content is intended for healthcare professionals only. Radcliffe brings medical knowledge, insight and innovation to life for CV clinicians around the world, using our communications & creative expertise, our platforms and connections across the community to help transform theory into practice faster. Like us on Facebook:   / radcliffecardiology   Follow us on X: https://x.com/radcliffeCARDIO