Digoxin Withdrawal in Stable Heart Failure

Inclusion criteria

• Over the age of 18 years
• In sinus rhythm at the time of randomisation
• Have a LVEF <0.45 and a left ventricular end-diastolic dimension >60 mm or >34 mm/m2
• Are receiving ACE inhibitor, β-blocker and diuretic therapy at the optimal doses.
• Has been receiving digoxin therapy for at least 3 months at a dose that results in digoxin plasma levels of 0.4-0.8 on 2 consecutive blood tests (at least 1 weeks apart) prior to randomisation. The dose of digoxin must remain stable for at least 2 weeks prior to randomisation.
• Documented, stable heart failure. Must have at least 1 of the following:

• Hospitalised with a discharge diagnosed of heart failure in the last 6 months
• Evidence of pulmonary congestion on chest X-ray
• Evidence of heart failure on echocardiogram
• Evidence of heart failure on ECG
• Willing and able to provide informed consent

Exclusion criteria

• Systolic BP >160mmHg or <90mmHg
• Diastolic BP >95mmHg
• Uncorrected primary valvular disease
• Active myocarditis
• Obstructive or restrictive Cardiomyopathy
• Exercise capacity limited by other factors not including dyspnoea
• Myocardial infarction within the previous 6 months
• Stroke within the previous 12 months
• Hospitalisation within one month of randomisation
• A history of supraventricular arrhythmia or sustained ventricular arrhythmia
• Claudication
• Severe primary pulmonary (VC <1.5L), renal or hepatic disease