Evidence map›Paper›PMID 40891341›Full record

Trial reportEuropean journal of heart failure2025

Low-dose digoxin improves cardiac function in patients with heart failure, preserved ejection fraction and atrial fibrillation - the RATE-AF randomized trial.

Karina V Bunting, Asgher Champsi, Simrat K Gill, Khalil Saadeh, A John Camm, Mary Stanbury, Sandra Haynes, Jonathon N Townend, Richard P Steeds, Dipak Kotecha and 1 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Karina V BuntingInstitute of Cardiovascular Science, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0003-4602-4377
Asgher ChampsiInstitute of Cardiovascular Science, University of Birmingham, Birmingham, UK.
Simrat K GillInstitute of Cardiovascular Science, University of Birmingham, Birmingham, UK.
Khalil SaadehUniversity Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
A John CammCardiology Clinical Academic Group Molecular & Clinical Sciences Institute, City St George's University of London, London, UK.
Mary StanburyPatient and Public Involvement team, Birmingham, UK.
Sandra HaynesPatient and Public Involvement team, Birmingham, UK.
Jonathon N TownendInstitute of Cardiovascular Science, University of Birmingham, Birmingham, UK.
Richard P Steeds *Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK.
Dipak Kotecha *Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK.
RAte control Therapy Evaluation in Permanent Atrial Fibrillation (RATE‐AF) Trial Group

Funding

Birmingham Biomedical Research Centre NIHR203326British Heart Foundation AA/18/2/34218British Heart Foundation FS/CDRF/21/21032Medical Research Council HDRUK/CFC/01National Institute for Health and Care Research CDF-2015-08-074
6 · The paper itself

Abstract

aimsTo compare the effect of digoxin versus beta-blockers on left ventricular function, in patients with permanent atrial fibrillation (AF) and symptoms of heart failure within the RATE-AF randomized trial. METHODS AND

resultsBlinded echocardiograms were performed at baseline and 12-month follow-up using a pre-defined imaging protocol and the index-beat approach. The change in systolic and diastolic function was assessed, stratified by left ventricular ejection fraction (LVEF). Overall, 145 patients completed follow-up, with median age 75 years (interquartile range 69-82) and 44% women. In 119 patients with baseline LVEF ≥50%, a significantly greater improvement in systolic function was noted in patients randomized to low-dose digoxin versus beta-blockers: adjusted mean difference for LVEF 2.3% (95% confidence interval [CI] 0.3-4.2; p = 0.021), s' 1.1 cm/s (95% CI 1.0-1.2; p = 0.001) and stroke volume 6.5 ml (95% CI 0.4-12.6; p = 0.037), with no difference in global longitudinal strain (p = 0.11) or any diastolic parameters. There were no significant differences between groups for patients with LVEF 40-49% and <40%. Digoxin reduced N-terminal pro-B-type natriuretic peptide compared to beta-blockers (geometric mean difference 0.77; 95% CI 0.64-0.92; p = 0.004), improved New York Heart Association functional class (odds ratio [OR] 11.3, 95% CI 4.3-29.8; p < 0.001) and modified European Heart Rhythm Association arrhythmia symptom class (OR 4.91, 95% CI 2.36-10.23; p < 0.001), with substantially less adverse events (incident rate ratio 0.21, 95% CI 0.13-0.31; p < 0.001). There were no interactions between treatment effects and baseline LVEF for these outcomes (interaction p = 0.62, 0.49, 0.07 and 0.13, respectively).

conclusionsLow-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.

Indexed as

Atrial FibrillationDigoxinHeart FailureStroke VolumeVentricular Function, LeftAdrenergic beta-AntagonistsAgedAged, 80 and overAnti-Arrhythmia AgentsCardiotonic AgentsDose-Response Relationship, DrugEchocardiographyFemaleFollow-Up StudiesHumansMaleAdrenergic beta-AntagonistsAnti-Arrhythmia AgentsCardiotonic AgentsDigoxinAtrial fibrillationBeta‐blockersDigoxinEchocardiographyHeart failure with preserved ejection fractionRandomized controlled trial

Identifiers

PMID40891341
PMCPMC12803603

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.