The epidemiologic features, causes, and prognosis of heart failure vary between men and women, sex-based 
differences in the effect of digoxin were unclear remained, according to one of New England Journal Medicine archives. After results reported by Digitalis Investigation Group, the American College of Cardiology and American Heart Association, the European Society of Cardiology, and the Heart Failure Society of America have issued clinical guidelines that strongly endorse the use of digoxin for patients with heart failure.
The Digitalis Investigation Group trial did not report sex-specific subgroup analyses, and current clinical guidelines do not differentiate between the use of digoxin in men and the use of this agent in women. Accordingly, researchers investigated whether the effect of digoxin therapy varied according to the sex of the patients in the Digitalis Investigation Group trial.
Saif S. Rathore, M.P.H., Yongfei Wang, M.S., and Harlan M. Krumholz, M.D. from the Section of Cardiovascular Medicine, Department of Internal Medicine Yale University School of Medicine, performed a post hoc subgroup analysis to assess whether there were sex-based differences in the effect of digoxin therapy among the 6800 patients in the Digitalis Investigation Group study.
Interaction between sex and digoxin therapy due to the primary end point of death from any cause was evaluated with the use of Mantel–Haenszel tests of heterogeneity and a multivariable Cox proportional-hazards model. In their result, they described about The Patients, Primary and Secondary Outcomes, Medication Doses, Serum Digoxin Levels, and Suspected Digoxin Toxicity.
In the efficacy of digoxin with no supported data concerning sex-based differences, the researchers underlined about the appropriate role of digoxin therapy in women as they stated in their final conclusion. In other words, Digoxin was associated with an increased risk of death among women but not among men.
The effect of digoxin therapy differs between men and women. Digoxin therapy is associated with an increased risk of death from any cause among women, but not men, with heart failure and depressed left ventricular systolic function.
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