Efficacy Study of Digoxin & Ivabradine to Treat Heart Failure

Cardiac Failure Clinical Trial

— Dig&Iva  

Official title:

Comparison of Digoxin and Ivabradine in Heart Failure With Preserved Systolic Function. Time to Rethink About Digoxin.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01699776
• Other study ID #: CG&PJ-Dig-Iva 2009-2012
• Status: Completed
• Phase: Phase 4
• First received: September 12, 2012
• Last updated: November 8, 2013
• Start date: April 2008
• Est. completion date: February 2012

Study information

• Verified date: October 2012
• Source: Cocco, Giuseppe, M.D.
• Contact: n/a
• Is FDA regulated: No
• Health authority: Switzerland: Laws and standards
• Study type: Interventional

Clinical Trial Summary

It is established that at a serum concentration 0.5-0.9 ng/ml digoxin is effective in patients with heart failure, especially in the presence of atrial fibrillation (AF). It is the claimed that ivabradine by lowering heart rate reduces symptoms and improves clinical outcomes in patients with heart failure. The effect of ivabradine and digoxin in heart failure was compared.

Patients 22 patients with ischemic heart failure, AF, and diastolic dysfunction with preserved left ventricular systolic function were treated with digoxin and ivabradine for 3 months, according to a randomization cross-over design.

Collected data Medical history, physical examination, laboratory (including proBNP and serum digoxin concentrations), ECG, 6-minute walk test, and echocardiographic data (LVEF, LAVi, e/e1 ratio).

Description:

Protocol This is an investigator-started study, coded GC&PJ-dig-Iva 2009-2012. The study was planned according to the Good Clinical Quality standards and the analysis was performed using an intention-to-treat method. The protocol was approved from an Ethics Committee. Selected patients gave their written informed consent. The family practitioners agreed and obtained the data and analysis. Collected data were analyzed from single-blinded investigators (without knowledge of the used test drug and time of collection).

Patients Study design: same patients were assigned to DIG or IVA for 3 months, according to a randomization cross-over design.

Tested drugs Commercial brands of digoxin and ivabradine were used. Digoxin was given by mouth at a dose of 0.125 mg/day, 5 times per week, for 3 months.

Ivabradine was given by mouth at a dose of 7.5 mg bid for 3 months.

Inclusion criteria Chronic and stable coronary artery disease Permanent atrial fibrillation. Diastolic dysfunction with maintained systolic function.

Exclusion criteria Unstable angina pectoris. Reduced systolic cardiac function (LVEF<52%). Normal diastolic function. Diabetes requiring insulin. Moderate or severe renal or hepatic dysfunction. Technically insufficient echocardiographic quality.

Collected data Medical history and concomitant medications. Physical examination was performed. Laboratory values (including proBNP and serum digoxin concentration). ECG. Echocardiography. 6-minute walk test.

Statistical Analyses Data are expressed as mean ± 1 SD. Absolute values and percent changes in relation to baseline measurements were analyzed. The 2 hypotheses tested were: null hypothesis: mu1-mu2=0.0, and alternative hypothesis: mu1-mu2>>0.0. Comparisons within groups were made using paired t tests or the non-parametric Wilcoxon signed-rank test, where appropriate. Between-group comparisons were performed by unpaired t tests or the non-parametric Mann-Whitney U test, respectively. Chi-square test or Kruskal-Wallis test were used to compare continuous normally or not normally distributed and qualitative variables, where appropriate. Multivariate analysis of variance was performed. A p value of < 0.05 was considered statistically significant.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 22
• Est. completion date: February 2012
• Est. primary completion date: February 2012
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 60 Years to 78 Years

Eligibility

Inclusion Criteria:

All patients had heart failure NYHA (New York Heart Association) class III. All had chronic and stable coronary artery disease which had been treated with percutaneous dilatation and stenting, and/or aortocoronary bypass. The pathology had induced a permanent AF and heart failure with left ventricular diastolic dysfunction and preserved systolic function. Preserved systolic function was defined by a LVEF (left ventricular ejection fraction) =52%. Left ventricular diastolic dysfunction was defined by a e/e1 ratio > 15 (septal spectral tissue-Doppler).

Exclusion Criteria:

Unstable myocardial ischemia, reduced systolic cardiac function (LVEF<52%), diabetes mellitus requiring insulin, moderate or severe renal or hepatic dysfunction, or technically insufficient echocardiography.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Investigator), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Cardiac Failure
• Heart Failure

Intervention

Drug:
• Ivabradine
7.5 my b.id. by mouth for 12-14 weeks
• Digoxin
1.25 mg once a day by mouth, for 12-14 weeks.

Locations

Country	Name	City	State
Switzerland	Cardiology office	Rheinfelden	Argovia

Sponsors (2)

Lead Sponsor	Collaborator
Cocco, Giuseppe, M.D.	Cardiology Office, Rheinfelden, Switzerland

Country where clinical trial is conducted

Switzerland, 

References & Publications (1)

Cocco G, Jerie P. Comparison between ivabradine and low-dose digoxin in the therapy of diastolic heart failure with preserved left ventricular systolic function. Clin Pract. 2013 Nov 4;3(2):e29. doi: 10.4081/cp.2013.e29. eCollection 2013 Aug 2. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Comparative therapeutic effect.	Effects on symptoms and signs of cardiac failure.	6 months	Yes