Randomized study assessing the effect of digoxin withdrawal in patients with mild to moderate chronic congestive heart failure: results of the PROVED trial. PROVED Investigative Group.
OBJECTIVE
The purpose of this study was to determine whether digoxin is effective in patients with chronic, stable mild to moderate heart failure.


BACKGROUND
Digoxin has been a traditional therapy in heart failure, but methodologic limitations in earlier studies have prevented definitive conclusions regarding its efficacy.


METHODS
Withdrawal of digoxin (placebo group, n = 46) or its continuation (digoxin group, n = 42) was performed in a prospective, randomized, double-blind, placebo-controlled multicenter trial of patients with chronic, stable mild to moderate heart failure secondary to left ventricular systolic dysfunction who had normal sinus rhythm and were receiving long-term treatment with diuretic drugs and digoxin.


RESULTS
Patients withdrawn from digoxin therapy showed worsened maximal exercise capacity (median change in exercise time -96 s) compared with that of patients who continued to receive digoxin (change in exercise time +4.5 s) (p = 0.003). Patients withdrawn from digoxin therapy showed an increased incidence of treatment failures (p = 0.039) (39%, digoxin withdrawal group vs. 19%, digoxin maintenance group) and a decreased time to treatment failure (p = 0.037). In addition, patients who continued to receive digoxin had a lower body weight (p = 0.044) and heart rate (p = 0.003) and a higher left ventricular ejection fraction (p = 0.016).


CONCLUSIONS
These data provide strong evidence of the clinical efficacy of digoxin in patients with normal sinus rhythm and mild to moderate chronic heart failure secondary to systolic dysfunction who are treated with diuretics.
Uretsky
B F
BF
Presbyterian University Hospital, Pittsburgh, Pennsylvania 15213.
Young
J B
JB
Shahidi
F E
FE
Yellen
L G
LG
Harrison
M C
MC
Jolly
M K
MK
D001835:Body Weight / Q000187:drug effects; D002908:Chronic Disease; D004077:Digoxin / Q000009:adverse effects* / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use; D004311:Double-Blind Method; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000187:drug effects*; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*; D013997:Time Factors; D017211:Treatment Failure; D016277:Ventricular Function, Left
D004232:Diuretics; D004077:Digoxin