Assessment and Effects of Circulating Cardiotonic Steroids in the RATE-AF Randomized Study Among Atrial Fibrillation and Heart Failure Patients

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Digoxin reduces heart failure-related death and hospitalizations but has no significant impact on all-cause mortality in randomized trials.
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The RATE-AF trial found low-dose digoxin to be equivalent to beta-blockers for quality of life and superior for other clinical outcomes in AF patients.
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Circulating cardiotonic steroids (CTS) may modulate digoxin's effects in patients with atrial fibrillation and heart failure.
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The study utilized high-fidelity mass spectrometry to quantify endogenous CTS levels in patients enrolled in the RATE-AF trial.
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The CTS sub-study aimed to evaluate the relationship between CTS levels and clinical outcomes in heart failure patients treated with digoxin.

Bmc Medicine

by Ioannis Akoumianakis, Lorna C. Gilligan, Karina V. Bunting, Dannie Fobian, Paulus Kirchhof, Wiebke Arlt, Angela E. Taylor, Davor Pavlovic, Dipak Kotecha
December 29, 2025

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