In patients with AF and HF , rate control compared with rhythm control showed inferior risk of hospitalisation
BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia that can promote or worsen heart failure ( HF ) .
Our purpose was to compare the effects of rate and rhythm control in patients with atrial fibrillation and heart failure .
Effectiveness of digoxin in reducing one-year mortality in chronic heart failure in the Digitalis Investigation Group trial.
Post hoc analyses of the Digitalis Investigation Group ( DIG ) trial indicate that digoxin at low ( 0.5 to 0.9 ng/ml ) serum digoxin concentration ( SDC ) reduces mortality , which is eliminated at higher ( > or=1 ng/ml ) SDC , and that low-dose digoxin ( < or=0.125 mg/day ) predicts low SDC . In the DIG trial , patients with ambulatory chronic systolic and diastolic heart failure ( HF ) ( n = 7,788 ) in normal sinus rhythm receiving angiotensin-converting enzyme inhibitors and diuretics were r and omized to receive placebo ( n = 3,899 ) or digoxin ( n = 3,889 ) . The median dose of digoxin ( 0.25 mg/day ) and the target SDC ( 0.8 to 2.5 ng/ml ) were higher than what are currently recommended , which in part may explain the lack of long-term mortality benefit of digoxin in the DIG trial . To test this hypothesis , we examined the effect of digoxin on short-term outcomes ; 1-year all-cause mortality occurred in 392 and 448 patients respectively in the digoxin and placebo groups ( hazard ratio for digoxin 0.87 , 95 % confidence interval [ CI ] 0.76 to 0.995 , p = 0.043 ) . Respective hazard ratios for cardiovascular and HF deaths were 0.87 ( 95 % CI 0.76 to 1.01 , p = 0.072 ) and 0.66 ( 95 % CI 0.52 to 0.85 , p = 0.001 ) . All-cause hospitalization occurred in 1,411 and 1,529 patients receiving digoxin and placebo respectively ( hazard ratio 0.89 , 95 % CI 0.83 to 0.96 , p = 0.002 ) . Respective hazard ratios for cardiovascular and HF hospitalizations were 0.82 ( 95 % CI 0.75 to 0.89 , p < 0.0001 ) and 0.59 ( 95 % CI 0.52 to 0.66 , p < 0.0001 ) . In conclusion , digoxin reduced 1-year mortality and hospitalization in patients with chronic HF receiving angiotensin-converting enzyme inhibitors and diuretics . R and omized clinical trials are needed to determine the effect of low-dose digoxin in contemporary patients with chronic HF
In patients with AF and HF , rate control compared with rhythm control showed inferior risk of hospitalisation
BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia that can promote or worsen heart failure ( HF ) .
Our purpose was to compare the effects of rate and rhythm control in patients with atrial fibrillation and heart failure .