Effect of digoxin vs. bisoprolol for heart rate control in AF on patient-reported quality of life

The RATE-AF study asked whether, among patients with permanent atrial fibrillation, quality of life changes depending on the choice of heart rate control therapy. The sample population included 160 U.K. participants aged 60 years or older who had symptoms of heart failure but no plans to restore sinus rhythm. One-half of the enrollees were randomly assigned to low-dose digoxin, and the other half received bisoprolol. The main outcome, evaluated at 6 months, was patient-reported quality of life based on physical component summary scores on the 36-item Short Form Health Survey. Those scores, with higher numbers reflecting better quality of life, came in at 31.5 for the digoxin patients and 29.3 for the bisoprolol patients. The difference was not statistically significant for the primary endpoint, nor for 16 of the 17 secondary outcomes. Based on the evidence, the investigators recommend potentially basing treatment decisions on other metrics.