Low-Dose Digoxin Improves Cardiac Function in Patients with Heart Failure, Preserved Ejection Fraction and Atrial Fibrillation – the RATE-AF Randomized Trial

Bunting, KV; Champsi, A; Gill, SK; Saadeh, K; Camm, AJ; Stanbury, M; Haynes, S; Townend, JN; Steeds, RP; Kotecha, D; RAte control Therapy Evaluation in Permanent Atrial Fibrillation (RATE‐AF) Trial Group

doi:10.1002/ejhf.70022

Heart failure & cardiomyopathies

Low-Dose Digoxin Improves Cardiac Function in Patients with Heart Failure, Preserved Ejection Fraction and Atrial Fibrillation – the RATE-AF Randomized Trial

Eur J Heart FailPublished 2 Sep 2025Secondary analysis of the RATE-AF randomised trial

Read the original article ↗PubMed

Cite

Authors' conclusion

Low-dose digoxin in patients with symptoms of heart failure, preserved LVEF and permanent AF leads to a significantly greater improvement in systolic function compared to treatment with beta-blockers.

Study context

Population: Patients with permanent atrial fibrillation (AF) and symptoms of HFcompleted follow-up
Participants: 145 patients

Comparison: Low-dose digoxin vs beta-blockers
Primary endpoint: Change in systolic and diastolic LV function, stratified by LVEF
Follow-up: 12 months

Methodological detailsblinded echocardiography, pre-defined imaging protocol

Blinded echocardiography
Pre-defined imaging protocol

Primary result

As reported in the abstract

Systolic function, baseline LVEF ≥50% (n = 119)

Digoxin vs Beta-blockersAdjusted mean difference, % (95% CI)P value

LVEF

2.3(0.3–4.2)

P = 0.021

Digoxin vs Beta-blockersAdjusted mean difference, cm/s (95% CI)P value

S'

1.1(1.0–1.2)

P = 0.001

Digoxin vs Beta-blockersAdjusted mean difference, ml (95% CI)P value

Stroke volume

6.5(0.4–12.6)

P = 0.037

No difference in global longitudinal strain: P = 0.11

Further findings

Outcome	← Lower with digoxin ←→ Higher with digoxin →	OR (95% CI)	P value
NT-proBNP, NYHA class, modified EHRA symptom classDigoxinvs Beta-blockersImproved NYHA class	0.050.21520	11.3 (4.3–29.8)	P < 0.001
NT-proBNP, NYHA class, modified EHRA symptom classDigoxinvs Beta-blockersImproved modified EHRA class	0.050.21520	4.91 (2.36–10.23)	P < 0.001
	0.050.21520Odds ratio (log scale)

Outcome	Geometric mean difference (95% CI)	P value
NT-proBNP, NYHA class, modified EHRA symptom classDigoxin vs Beta-blockers · NT-proBNP	0.77 (0.64–0.92)	P = 0.004

NT-proBNP, NYHA class, modified EHRA symptom class: interaction with baseline left ventricular ejection fraction (LVEF): p = 0.62, 0.49, 0.07

LV function, baseline LVEF 40-49% and <40% (subgroups)

No significant differences between groups

Safety

Outcome	← Lower risk with digoxin ←→ Higher risk with digoxin →	IRR (95% CI)	P value
Adverse eventsFewer with digoxin	0.10.31310	0.21 (0.13–0.31)	P < 0.001
	0.10.31310Incidence rate ratio (log scale)

Adverse events: interaction with baseline LVEF p = 0.13

Original publication

Low-Dose Digoxin Improves Cardiac Function in Patients with Heart Failure, Preserved Ejection Fraction and Atrial Fibrillation – the RATE-AF Randomized Trial. Eur J Heart Fail. Published 2 September 2025. doi:10.1002/ejhf.70022

Read the original article ↗

Composed by AI from the published abstract and checked against it. How Briefs are made →