Evaluating digoxin treatment in patients with rheumatic heart disease - A randomised placebo-controlled trial
Background
Digoxin is widely used in the medical management of patients with rheumatic heart disease (RHD), atrial fibrillation (AF), and for the treatment of heart failure (HF). Observational data from older patients with non-valvular AF suggest a higher mortality risk among those who received digoxin. However, patients with RHD are younger, without associated comorbidity, and it is unclear if digoxin will have similar adverse effects in these patients.
Extrapolating the results of studies in patients without valve disease, to patients with RHD may result in the underuse of an inexpensive treatment which has proven benefit in reducing hospitalisation for worsening HF. Therefore, there is a clear need for an adequately powered randomized controlled trial to answer: How does digoxin use affect mortality in patients with RHD? Does digoxin use reduce the incidence of worsening heart failure in patients with RHD?
Aim
To determine whether the use of digoxin in symptomatic patients with RHD af