Evidence map›Paper›PMID 39819610›Full record

Trial reportHeart (British Cardiac Society)2025

Cost-effectiveness of digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) randomised trial.

Zainab Abdali, Karina V Bunting, Samir Mehta, John Camm, Kazem Rahimi, Mary Stanbury, Sandra Haynes, Dipak Kotecha, Sue Jowett

Registry-linked trialAbstract readRandomized Controlled TrialMulticenter StudyComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Heart (British Cardiac Society), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02391337 (Evaluating Different Rate Control Therapies in Permanent Atrial Fibrillation), which is not on this 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.

NCT02391337 phase4completednot on this map

Evaluating Different Rate Control Therapies in Permanent Atrial Fibrillation: A Prospective, Randomised, Open-label, Blinded Endpoint Feasibility Pilot Comparing Digoxin and Beta-blockers as Initial Rate Control Therapy

TypeinterventionalSponsorUniversity of BirminghamRan2016 to 2019Enrolled161ConditionsPermanent Atrial FibrillationArmsBisoprolol, Digoxin
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Article
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

9 authors.

Zainab AbdaliHealth Economics Unit, School of Health Sciences, University of Birmingham, Birmingham, UK.ORCID 0000-0002-2736-5427
Karina V BuntingDepartment of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.ORCID 0000-0003-4602-4377
Samir MehtaBirmingham Clinical Trials Unit, School of Health Sciences, University of Birmingham, Birmingham, UK.
John CammCardiology Clinical Academic Group, St George's University of London, London, UK.ORCID 0000-0002-2536-2871
Kazem RahimiDeep Medicine, Nuffield Department of Reproductive and Women's Health, University of Oxford, Oxford, UK.
Mary StanburyPatient and Public Involvement Team, RATE-AF Trial, University of Birmingham, Birmingham, UK.
Sandra HaynesPatient and Public Involvement Team, RATE-AF Trial, University of Birmingham, Birmingham, UK.
Dipak KotechaDepartment of Cardiovascular Sciences, University of Birmingham, Birmingham, UK s.jowett@bham.ac.uk d.kotecha@bham.ac.uk.ORCID 0000-0002-2570-9812
Sue JowettHealth Economics Unit, School of Health Sciences, University of Birmingham, Birmingham, UK s.jowett@bham.ac.uk d.kotecha@bham.ac.uk.

Funding

British Heart Foundation AA/18/2/34218
6 · The paper itself

Abstract

backgroundAtrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with permanent AF and symptoms of heart failure.

methodsRAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) was a randomised, open-label, blinded, endpoint trial embedded in the UK National Health Service (NHS) to directly compare low-dose digoxin with beta-blockers (ClinicalTrials.gov: NCT02391337). A trial-based cost-utility analysis was performed from a healthcare perspective over 12 months. Resource use in primary and secondary healthcare services, medications and patient-reported quality of life were prospectively collected to estimate differences in costs and quality-adjusted life years (QALYs).

resultsRATE-AF randomised 160 patients with mean age of 76 (SD 8) years and 46% women, of which 149 patients (n=73 digoxin, n=76 beta blockers) had complete data and survived to 12-month follow-up. Treatment with digoxin was significantly less costly, with a mean saving of £530.41 per patient per year (95% CI -£848.06 to -£249.38, p=0.001). This was principally due to substantially lower rates of adverse events, with less primary and secondary healthcare utilisation compared with beta-blocker therapy. There was no significant difference in QALYs (0.013; 95% CI -0.033 to 0.052, p=0.56). At the £20 000 per-QALY willingness to pay threshold, the probability of digoxin being cost-effective compared with beta-blockers was 94%, with potential annual savings to the NHS of £102 million/year (95% CI £48 million to £164 million saving, p=0.001).

conclusionsDigoxin is a less costly option when compared with beta-blockers for control of heart rate in suitable patients with permanent AF, with larger cost-effectiveness studies warranted to advise on national and global policy-making. TRIAL REGISTRATION NUMBER: NCT02391337, EudraCT 2015-005043-13.

Indexed as

Adrenergic beta-AntagonistsAnti-Arrhythmia AgentsAtrial FibrillationDigoxinDrug CostsHeart RateAgedAged, 80 and overCost-Benefit AnalysisFemaleHumansMaleProspective StudiesQuality-Adjusted Life YearsQuality of LifeTreatment OutcomeAdrenergic beta-AntagonistsAnti-Arrhythmia AgentsDigoxinAtrial FibrillationHealth Care Economics and OrganizationsQuality of Health Care

Identifiers

PMID39819610
PMCPMC12015011

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

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 OpenQuestion graph.