Digoxin is a compound that has been utilised in cardiovascular therapy for a long time. Nonetheless, its mode of action and, more crucially, its clinical value have been a source of contention. Digoxin has positive inotropic and neurohormonal modulation effects, and it has been the mainstay of heart failure therapies for decades. Digoxin prescription rates have been in free decrease since the introduction of β-blockers and aldosterone antagonists as part of modern heart failure medical care. The fact that digoxin is still recommended as a treatment option in both American and European heart failure guidelines hasn't changed specialists' minds.A succession of papers based primarily on observational studies and post hoc analysis has raised questions about the clinical efficacy and long-term safety of digoxin since the release of the initial Digitalis Investigation Group trial findings. We will conduct a thorough assessment of the available clinical evidence on the efficacy and safety of digoxin in heart failure patients with a lower ejection fraction in this paper. Individual studies' methodological challenges, strengths, and limitations will be emphasised.