Digoxin or bisoprolol did not improve quality of life in AF patients with HF: JAMA

England: Treatment with low-dose digoxin or bisoprolol in patients with permanent atrial fibrillation and heart failure symptoms did not make any significant difference in quality of life at 6 months, reveals a recent study in the journal JAMA.

There is not enough evidence to support selection of heart rate control therapy in patients having permanent atrial fibrillation, particularly in those with coexisting heart failure. Considering this, Dipak Kotecha, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, England, and colleagues designed the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) trial. The trial was designed to compare patient-reported quality of life among patients with permanent AF and symptoms of heart failure treated with low-dose digoxin or bisoprolol for heart rate control.

The trial included 160 patients (aged 60 years and older) with permanent atrial fibrillation (defined as no plan to restore sinus rhythm) and dyspnea classified as New York Heart Association class II or higher. The patients were recruited from 3 hospitals and primary care practices in England from 2016 through 2018; last follow-up occurred in October 2019.

The patients were randomized to receive either digoxin (n = 80; dose range, 62.5-250 μg/d; mean dose, 161 μg/d) or bisoprolol (n = 80; dose range, 1.25-15 mg/d; mean dose, 3.2 mg/d). Among 160 patients 145 (91%) completed the trial and 150 (94%) were included in the analysis for the primary outcome.