The Rhythm | Issue 6
Issue 6 | Week of 11 May 2026
Heart Failure 2026 is taking place in Barcelona from 9 to 12 May, dominating this week's evidence with four major publications across Nature Medicine and JAMA.
Cardiology Intelligence Briefing: old drugs, new evidence
Heart Failure 2026 week produced an unexpected protagonist: digitalis. Three papers, two from the Groningen group and one from the All India Institute of Medical Sciences, recast a drug introduced into medicine in 1785 as a contemporary heart failure therapy. The first dedicated trial of low-dose digoxin in the four-pillar era enrolled 1,001 patients with reduced or mildly reduced left ventricular ejection fraction (LVEF) and returned a neutral primary composite, with the direction of effect favouring digoxin and no excess mortality.1 A study-level meta-analysis pooling 9,013 participants from this and two prior trials showed a 15% reduction in the composite of cardiovascular death or first worsening heart failure event, driven entirely by the heart failure component.2 In symptomatic rheumatic heart disease, a population almost absent from contemporary trial programmes, a separate trial reported the same direction of benefit.3
At the other end of the therapeutic timeline, a phase 2 trial of CDR132L, an antisense inhibitor of microRNA-132 and the first such therapy randomised in heart failure after myocardial infarction (MI), failed to improve left ventricular end-systolic volume index (LVESVI) at six months despite confirmed target engagement.4 In Kenya, an artificial intelligence (AI)-augmented electrocardiogram (ECG) screening tool identified echocardiographically confirmed left ventricular systolic dysfunction (LVSD) with sensitivity above 95% and negative predictive value (NPV) above 99%, extending a diagnostic approach validated in high-income systems into a setting where echocardiography is rarely accessible.5
This was a week unflattering to the field's appetite for novelty: a drug from the 18th century gained its strongest randomised support in three decades, a precision RNA therapy missed its primary endpoint, and a low-cost diagnostic delivered where access matters most. Old drugs, new evidence.
