Heart failure & cardiomyopathiesSecondary analysis
Low-Dose Digoxin Improves Cardiac Function in Patients with Heart Failure, Preserved Ejection Fraction and Atrial Fibrillation – the RATE-AF Randomized Trial
- Secondary analysis of the RATE-AF randomised trial
- blinded echocardiography
- pre-defined imaging protocol
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
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 = 0.021Digoxin vs Beta-blockersAdjusted mean difference, cm/s (95% CI)P value
s'
1.1(1.0–1.2)
P = 0.001Digoxin 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 | geometric mean difference (95% CI) | P value | |
|---|---|---|---|
| NT-proBNP, NYHA class, modified EHRA symptom class — Digoxin vs Beta-blockers · NT-proBNP | 0.77 (0.64–0.92) | P = 0.004 | |
| −0.500.51Difference (linear scale) |
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| NT-proBNP, NYHA class, modified EHRA symptom class — Digoxin vs Beta-blockers · improved NYHA class | 11.3 (4.3–29.8) | P < 0.001 | |
| NT-proBNP, NYHA class, modified EHRA symptom class — Digoxin vs Beta-blockers · improved modified EHRA class | 4.91 (2.36–10.23) | P < 0.001 | |
| 0.050.21520Odds ratio (log scale) |
- 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 | IRR (95% CI) | P value | |
|---|---|---|---|
| Adverse events · fewer with digoxin | 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
Summarised from the published abstract; every number is checked against it