Clinical Research Directory

Inclusion Criteria: * Able to provide informed written consent. * Male or female aged ≥18 years old. * Admitted for acute heart failure defined by the presence of dypnea at rest or with minimal exertion , pulmonary congestion on chest radiograph ; and increased natriutic peptide concentrations ( BNP \>=350 pg/ml) or NTproBNP \>=1400 pg/ml ) . * Able to be randomized within 12 hours from presentation to the hospital. Exclusion Criteria: * Pregnant or breast feeding women. * Known severe or terminal renal failure. * Severe hepatic impairment. * Major surgery within 30 days. * Hematocrit \< 25%. * Alteration of consciousness GCS \< 15 * Critically ill patients needing immediate mechanical hemodynamic of ventilatory support. * Confirmed or suspected diagnosis of ACS within 45 days before inclusion. * Severe arrhythmias including significant sinoatrial or atrioventricular blocks or WPW syndrome. * Implantable cardiac devices including pacemakers and defibrillators. * Hypertrophic obstructive, restrictive, or constrictive cardiomyopathy. * Noncardiac pulmonary edema, including suspected sepsis. * Severe pulmonary disease * Significant stenotic valvular disease . * Hyperkalemia \> 5.5 mmol /L . * Administration of an investigational drug or implantation of an investigational device or participation in another trial within 30 days before screening. * Previous treatment with digoxin before inclusion or contra-indications to digoxin. * Inability to follow instructions or comply with follow-up procedures.