Digoxin, Again, for Permanent Atrial Fibrillation?

Digoxin has a storied past for the treatment of heart failure and atrial fibrillation (AF). William Withering first described its use for dropsy (edema) in 1785. Since that time, studies of its use have variously shown benefit and harm for the two conditions. In a 2014 observational study, researchers found elevated mortality with digoxin in patients with AF, and thus its use has declined.

Now, researchers in the U.K. randomized 160 patients aged ≥60 and with heart failure and permanent AF to open-label digoxin or bisoprolol (NCT02391337). Patients' mean baseline heart rate was 100 bpm. The medications were uptitrated as tolerated. At 6 and 12 months, the groups did not differ in the primary endpoint, quality of life as measured by the physi…