Clinical Research Directory

Inclusion Criteria: 1. Age ≥18year 2. Outpatients with chronic HF, New York Heart Association \[NYHA\] class II - ambulatory IV 3. LVEF\<50% 4. Serum NT-proBNP concentrations: Previous HF hospitalization ≤ 1 year before randomisation ≥400pg/mL if sinus rhythm; ≥800pg/mL if AF Previous HF hospitalization \> 1 year before randomisation or in the absence of HF hospitalizations ≥ 600pg/mL if sinus rhythm; ≥1000 pg/mL if AF BNP concentrations: Previous HF hospitalization ≤ 1 year before randomisation ≥100pg/mL if sinus rhythm; ≥200pg/mL if AF Previous HF hospitalization \> 1 year before randomisation or in absence of HF hospitalization ≥150pg/mL if sinus rhythm; ≥250pg/mL if AF. 5. ≥14 days stable on guideline-recommended therapy (doses and number of therapies as tolerated by each patient) Exclusion Criteria: 1. Heart rate ≤60bpm (if sinus rhythm); heart rate ≤70bpm (if AF) 2. History of HF hospitalization ≤7days 3. History of myocardial infarction, myocarditis, percutaneous intervention, RCT, pacemaker/ICD implantation, cardiac surgery or stroke ≤30 days 4. Estimated glomerular filtration rate (eGFR), ≤30ml/min/1.73m2 5. The presence of a mechanical assist device 6. Use of inotropic drugs (dopamine, dobutamine, (nor)adrenaline, and milrinon) 7. Scheduled for mechanical assist device or heart transplant 8. Other non-cardiac conditions with limited life expectancy (≤ duration of the study) 9. Amyloid, hypertrophic obstructive or constrictive cardiomyopathy 10. Accessory atrio-ventricular pathway (e.g. Wolf-Parkinson-White syndrome) 11. (Intermittent) complete heart block or second-degree AV block type Mobitz without pace maker or ICD 12. Severe (grade III/III) aortic valve disease 13. Complex congenital heart disease 14. Proven hypersensitivity to digoxin (prior side effects) 15. Concomitant medication that interacts with digoxin 16. Use of digoxin ≤6 months prior to inclusion 17. Participation in another (intervention) clinical trial (registry studies not included) 18. Women who are pregnant, breastfeeding or may be considering pregnancy during the study period