In a patient with chronic heart failure with reduced ejection fraction already on guideline-directed medical therapy, what benefit does adding digoxin provide?

• A Reduces all-cause mortality
• B Prevents sudden cardiac death
• C Improves survival and reverses ventricular remodeling
• D Reduces heart failure hospitalizations without mortality benefit ✓

Explanation

Digoxin inhibits the sodium-potassium ATPase, increasing contractility and vagal tone, and provides symptomatic relief with fewer heart failure hospitalizations. However, trials show it is neutral for mortality, unlike ACE inhibitors, beta-blockers, MRAs, and ARNI therapy, which is precisely what separates it from the mortality-benefit distractors. Narrow therapeutic index and toxicity risk, including arrhythmias with hypokalemia, further limit its role to symptom control.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.