#ESC2020 RATE-AF Digoxin v Bisoprolol for rate control

The RATE-AF trial showed that digoxin was associated with symptom improvement and reduction in NT-proBNP compared with a beta-blocker. 

Description:

The goal of the trial was to evaluate digoxin compared with beta-blocker among patients with permanent atrial fibrillation.

Study Design

Randomized, Parallel, Open-label

Eligible patients were randomized to digoxin (n = 80) vs. beta-blocker (n = 80). Patients randomized to a beta-blocker received bisoprolol.

  • Total number of enrollees: 160

  • Duration of follow-up: 12 months

  • Mean patient age: 76 years

  • Percentage female: 46%

Inclusion criteria:

  • ≥60 years of age

  • Permanent atrial fibrillation

  • New York Heart Association (NYHA) ≥ class II

Exclusion criteria:

  • Heart rate <60 bpm

  • Need for beta-blocker based on heart failure or ejection fraction (EF)

  • Heart rate reduction was similar between treatment groups at 12 months

Results

The primary outcome, patient-reported quality of life at 6 months, was similar between the groups (p = 0.30). Some quality of life measures favoured digoxin at 12 months.

Secondary outcomes:

  • NYHA class: In the digoxin group, 2.4 at baseline and 1.5 at 12 months. In the beta-blocker group, 2.4 at baseline and 2.0 at 12 months (p < 0.001).

  • N-terminal pro–B-type natriuretic peptide (NT-proBNP): In the digoxin group, 1,095 at baseline and 960 at 12 months. In the beta-blocker group, 1,041 at baseline and 1,250 at 12 months (p = 0.005).

  • Left ventricular EF (LVEF): In the digoxin group, 56.2% at baseline and 59.7% at 12 months. In the beta-blocker group, 57.6% at baseline and 59.8% at 12 months (p = 0.45).

  • Adverse events: In the digoxin group, there were 29 events vs. 142 events in the beta-blocker group (p < 0.001).

Conclusions

Among patients with permanent atrial fibrillation, digoxin compared with beta-blocker failed to improve quality of life measures at 6 months. Digoxin improved some measures of quality of life at 12 months and was associated with greater reductions in NYHA class and NT-proBNP. Digoxin was also associated with fewer adverse events compared with beta-blockers.

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