LAUSR

Since the DIG study,1 which demonstrated that whilst digoxin reduced hospitalization for heart failure (HF), there was no significant overall effect on mortality, the place of digoxin in treating HF has steadily declined over recent years and has been debated.2 Selection of heart rate control therapy in patients with permanent atrial fibrillation (AF), particularly those with coexisting HF, is still an issue.3 In the recent RATE-AF trial that included patients with permanent AF and symptoms of HF, treatment with digoxin or bisoprolol did not result in a significant difference in quality of life at 6 months.4 We analysed whether the clinical outcomes differed among such patients with permanent AF and HF who are treated with either digoxin or beta-blocker in a ‘real-life’ observational study. All patients who were treated for AF in our academic institution were identified using a local database. The information for each patient was extracted from computerized data of hospitalization and consultation of our institution. We examined the clinical course of 8962 consecutive patients with AF seen over a 10-year period (2000–2010).5,6 Among them, 1787 patients met the inclusion criteria of RATE-AF (permanent AF, age ≥60 years and New York Heart Association functional class ≥2), of whom 512 patients (29%) were treated with beta-blocker alone, 425 (24%) were treated with digoxin alone and 237 (13%) were treated with both a beta-blocker and digoxin. Adverse outcomes were investigated during follow-up and we identified the causes of death. Owing to the non-randomized nature of the study, and considering for significant differences in baseline characteristics, propensity-score matching was used to control for potential confounders of the treatment outcome relationship considering the covariates listed in Table 1 Characteristics of matched patients aged ≥60 years with permanent atrial fibrillation and heart failure treated with digoxin or beta-blocker