Sarwar Muhammad, Nahar Noor Un, Amin Hajra, Iqbal Maheen, Bader Aymen
Cardiology, Punjab Institute of Cardiology, Lahore, PAK.
Acute Internal Medicine, Northampton General Hospital, Northampton, GBR.
Cureus. 2025 Aug 15;17(8):e90171. doi: 10.7759/cureus.90171. eCollection 2025 Aug.
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.
引言 心房颤动（AF）与心力衰竭（HF）常并存，对患者的发病率、生活质量（QOL）和死亡率产生协同不良影响。与窦性心律人群相比，这也给房颤人群中的心力衰竭管理带来了独特挑战。虽然比索洛尔等β受体阻滞剂一直是心力衰竭患者的首选治疗方案，但地高辛仍是一种性价比高却被低估的替代药物。然而，其对生活质量的总体影响仍存在争议，尤其是在心力衰竭负担高于其他任何种族的南亚人群中。
目的 本研究的目的是比较比索洛尔与地高辛对南亚永久性房颤并发心力衰竭患者生活质量的短期影响。
方法 本单中心前瞻性随机对照研究于2022年3月至9月在拉合尔旁遮普心脏病学研究所门诊部进行。共纳入80例永久性房颤且确诊心力衰竭的患者，并随机分为两组，分别接受地高辛（62.5 - 250微克/天）或比索洛尔（1.25 - 15毫克/天）治疗。在基线和三个月后采用36项简短健康调查问卷（SF - 36）评估生活质量的变化。使用SPSS v25.0（美国纽约州阿蒙克市IBM公司）进行数据分析，p≤0.05为有统计学意义。
结果 三个月后，两个治疗组的SF - 36生活质量评分均显著改善（p < 0.001）。然而，地高辛组的改善程度显著高于比索洛尔组（平均生活质量评分：76.68±9.37对70.90±8.00；p = 0.004）。两组均未报告严重不良事件或地高辛相关毒性。
结论 在永久性房颤和心力衰竭患者中，与比索洛尔相比，地高辛在短期内使生活质量有统计学意义的改善。这些发现表明，在永久性房颤和心力衰竭患者中，地高辛可能是比索洛尔可行且可能更优的替代药物，在特定人群中地高辛有作为一线药物的潜在作用。这也凸显了重新评估当前治疗偏好的必要性，尤其是在资源有限的环境中。需要进一步的多中心和多民族研究来证实这些发现并评估长期临床结局。
