Effect of Digoxin Versus Bisoprolol for Heart Rate Control in Atrial Fibrillation With Heart Failure on Quality of Life: A Prospective Randomised Comparative Study.

Introduction Atrial fibrillation (AF) and heart failure (HF) often co-exist, exerting synergistic adverse effects on patients' morbidity, quality of life (QOL) and mortality. This also poses a unique management challenge of heart failure in the AF population as compared to the sinus rhythm population. While beta blockers such as bisoprolol have been preferred treatment options for patients with heart failure, digoxin remains a cost-effective yet underrated alternative. However, its overall effect on QOL remains debated, especially in the South Asian population that carries a higher burden of heart failure than any other ethnicity. Objective The objective of this study was to compare the short-term effect of bisoprolol versus digoxin on quality of life in patients with permanent AF and concurrent HF in the South Asian population.  Methods This single-centred prospective randomised comparative study was conducted at the outpatient department of Punjab Institute of Cardiology, Lahore, from March to September 2022. A total of 80 patients with permanent AF and established HF were enrolled and randomised in two groups to receive either digoxin (62.5-250 mcg/day) or bisoprolol (1.25-15 mg/day). The 36-Item Short Form Health Survey (SF-36) was administered at baseline and after three months to assess changes in QOL. Data were analysed using SPSS v25.0 (IBM Corp., Armonk, NY, USA), with significance at p ≤ 0.05. Results Both treatment groups significantly improved SF-36 QoL scores after three months (p < 0.001). However, the digoxin group reported significantly greater improvement compared to the bisoprolol group (mean QoL score: 76.68 ± 9.37 vs. 70.90 ± 8.00; p = 0.004). No serious adverse events or digoxin-related toxicities were reported in either group.  Conclusion In patients with permanent AF and HF, digoxin resulted in a statistically significant improvement in short-term quality of life compared to bisoprolol. These findings suggest that digoxin may serve as a viable and possibly superior alternative to bisoprolol in patients with permanent AF and HF, with a potential role for digoxin as a first-line agent in select populations. It also highlights the need to re-evaluate current treatment preferences, especially in resource-limited settings. Further multicentric and multi-ethnic studies are needed to substantiate these findings and evaluate long-term clinical outcomes.