Low-dose digoxin improves cardiac function in patients with heart failure, preserved ejection fraction and atrial...

Area of Science:

• Cardiology
• Pharmacology
• Heart Failure Research

Background:

• Permanent atrial fibrillation (AF) often coexists with heart failure.
• Left ventricular (LV) function is crucial in managing heart failure patients.
• Optimal medical therapy for heart failure in AF requires careful consideration of LV function effects.

Purpose of the Study:

• To compare the effects of digoxin versus beta-blockers on left ventricular function.
• To assess impacts on systolic and diastolic function in patients with permanent atrial fibrillation and heart failure symptoms.
• To evaluate clinical outcomes including heart failure symptoms and adverse events.

Main Methods:

• The RATE-AF randomized trial compared low-dose digoxin to beta-blockers.
• Blinded echocardiograms assessed systolic and diastolic function at baseline and 12 months.
• Analysis stratified by baseline left ventricular ejection fraction (LVEF).

Main Results:

• In patients with preserved LVEF (≥50%), digoxin showed significantly greater improvement in LVEF, s', and stroke volume compared to beta-blockers.
• Digoxin reduced N-terminal pro-B-type natriuretic peptide levels and improved functional and arrhythmia symptom classes.
• Digoxin was associated with substantially fewer adverse events than beta-blockers.

Conclusions:

• Low-dose digoxin offers superior improvement in systolic function for heart failure patients with permanent AF and preserved LVEF compared to beta-blockers.
• Digoxin demonstrates benefits in reducing heart failure markers, improving symptoms, and lowering adverse events in this specific patient population.