Why Discontinuing Digoxin in Heart Failure May Lead to Rehospitalization

Key Takeaway

Deprescribing long-term, low-dose digoxin in patients with heart failure who are already receiving contemporary guideline-directed medical therapy is far from a benign strategy for regimen simplification. In a blinded, randomized withdrawal trial, discontinuing digoxin precipitated objective hemodynamic deterioration alongside a more than sevenfold surge in clinical events within six weeks. Discontinuing digoxin demands the same degree of clinical vigilance as initiating it.

A Seemingly Redundant Medication Regimen

A 71-year-old man with heart failure with reduced ejection fraction has remained clinically stable for the past three years. His therapeutic regimen mirrors contemporary guidelines: a beta-blocker, an angiotensin receptor-neprilisin inhibitor, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor. Toward the bottom of his medication list sits low-dose digoxin—a therapeutic agent with clinical roots dating back more than 250 years^[2]. During a routine follow-up visit, a new cardiologist views the regimen through the lens of deprescribing: fewer pills, reduced toxicity risk, and a streamlined prescription. Digoxin…