Does digoxin decrease morbidity for those in sinus rhythm with heart failure?

In patients with congestive heart failure due to systolic dysfunction who are in normal sinus rhythm, digoxin therapy reduces rates of hospitalization, as well as clinical deterioration, defined as worsening New York Heart Association (NYHA) classification or an increase in clinical signs and symptoms (strength of recommendation [SOR]: A, systematic review of randomized controlled trials [RCT]). These benefits appear to be more pronounced for men. Patients treated with digoxin are at increased risk of developing supraventricular dysrhythmias and second- or third-degree atrioventricular block (SOR: A, large RCT). It is unclear if patients with diastolic dysfunction experience similar benefits or harms (SOR: A, systematic review of RCTs). Digoxin has not been shown to have any effect on mortality for men with congestive heart failure in sinus rhythm (SOR: A, systematic review of RCTs). Digoxin use for women may be associated with an increased risk of mortality (SOR: B, extrapolation from RCT)