Is the Quality of Life for Patients with Atrial Fibrillation and Heart Failure Comparable When Treated with Bisoprolol and Digoxin?
The British RATE-AF study, published in December 2020 in the JAMA journal, compared the impact on improving the quality of life in patients with permanent atrial fibrillation (AF) and symptoms of heart failure when administering bisoprolol and low-dose digoxin.
Compared Treatment
This randomized open-label study with a blinded endpoint included 160 patients over 60 years old with permanent AF (defined by the absence of planned sinus rhythm restoration) and dyspnea class ≥ II according to the NYHA classification. For heart rate control, either digoxin (average dose of 161 µg/day, range 62.5–250 µg/day) or bisoprolol (average dose of 3.2 mg/day, range 1.25–15 mg/day) was administered.
Quality of Life Assessment Method
The primary endpoint was the quality of life assessed by the patient according to the overall score of the physical health component of the 36-item Short Form Health Survey (SF-36 PCS) after 6 months. This scale ranges from 0 to 100, with a higher score indicating a better quality of life. The minimum clinically significant difference was defined as half a standard deviation (SD).
Significant Differences in Quality of Life Not Found
The average age of the patients was 76 years, 46% were women, and the baseline heart rate was 100 bpm. The results showed no significant difference in SF-36 PCS scores after 6 months of treatment. In the bisoprolol group, this score averaged 31.9 (SD 11.7), in the digoxin group, 29.7 (SD 11.4): adjusted mean difference 1.4 (95% confidence interval [CI] –1.1 to 3.8; p = 0.28).
Conclusion
In patients with permanent AF and symptomatic heart failure, no statistically significant difference was found in the quality of life after 6 months of treatment with digoxin or bisoprolol. According to the authors of the cited work, the choice between these two drugs for the given indication should be based on other target parameters.
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Source:
Kotecha D., Bunting K. V., Gill S. K. et al.; Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) Team. Effect of digoxin vs bisoprolol for heart rate control in atrial fibrillation on patient-reported quality of life: the RATE-AF randomized clinical trial. JAMA 2020 Dec 22; 324 (24): 2497–2508, doi: 10.1001/jama.2020.23138.
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