Do the Favorable Effects of Digoxin and SGLT2 Inhibitors Really Differ in Patients with Heart Failure and a Reduced Ejection Fraction? A Provocative Side-by-Side Examination of Trial Outcomes

In the 2021 heart failure guidelines from the European Society of Cardiology, there is a striking difference in the recommendations for the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors and digoxin. SGLT2 inhibitors have a class IA recommendation, and their use is strongly advocated for all patients with heart failure and a reduced ejection fraction (HFrEF). In contrast, digoxin carries a class IIB recommendation that suggests its possible consideration in patients with HFrEF in sinus rhythm.

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