What does this research mean for the field?

The combination of carvedilol and digoxin is superior to either carvedilol or digoxin monotherapy for lowering ventricular rate and improving left ventricular ejection fraction in patients with persistent atrial fibrillation and heart failure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether carvedilol alone, digoxin alone, or their combination provides optimal rate control, cardiac function, and symptom relief in patients with persistent atrial fibrillation and heart failure.

August 28, 2026Journal of the American College of CardiologyOpen Access

Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure?

Q: What are the key findings of this study?

Combination therapy with carvedilol and digoxin lowered ventricular rate (P<0.0001) and improved LVEF compared to digoxin alone in patients with persistent atrial fibrillation and heart failure.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: persistent atrial fibrillation and heart failure (n=47). Intervention: Carvedilol and digoxin combination therapy vs. Digoxin alone. Primary outcome: ventricular rate on 24-h ambulatory electrocardiographic monitoring (p=<0.0001).

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Key result

Adding carvedilol to digoxin lowers ventricular rate and improves LVEF in persistent AF and HF.

P<0.0001
n=47

Why the study?

Both digoxin and beta-blockers reduce ventricular rate in AF and HF, but it was unclear whether combined therapy is superior to beta-blockers alone, which could allow simplifying therapy by stopping digoxin.

Does carvedilol alone or in combination with digoxin improve ventricular rate and symptoms compared to digoxin alone in patients with heart failure and persistent atrial fibrillation?

Population

47 patients with persistent AF and HF (mean LVEF 24%)

Design

Randomized double-blinded placebo-controlled study

Authors

AKAleem KhandUniversity of Liverpool ARAndrew RankinAssociation of Community College Trustees WMWilliam MartinMarquette University

Discussion

Member takes

Implication

The combination of carvedilol and digoxin is superior to either agent alone for rate control and improving LVEF in patients with heart failure and persistent atrial fibrillation.

Key Points

To determine whether carvedilol alone, digoxin alone, or their combination provides optimal rate control, cardiac function, and symptom relief in patients with persistent atrial fibrillation and heart failure.
Conducted a randomized, double-blind, placebo-controlled trial in 47 patients (29 males; mean age 68 years; mean left ventricular ejection fraction 24%) with persistent atrial fibrillation and heart failure.
Evaluated digoxin alone versus digoxin plus carvedilol over a 4-month first phase, followed by a double-blind withdrawal of digoxin in the carvedilol arm to compare digoxin alone against carvedilol alone over a 6-month second phase.
Compared with digoxin alone, combination therapy significantly reduced 24-hour ambulatory ventricular rate (p < 0.0001) and submaximal exercise rate (p < 0.05), while significantly improving left ventricular ejection fraction (p < 0.05) and symptom scores (p < 0.05).
In Phase 2, carvedilol monotherapy showed no significant differences compared to digoxin monotherapy, but switching from combination therapy to carvedilol alone led to an increased ventricular rate and decreased ejection fraction.
Six-minute walk distance was not significantly altered across any of the treatment regimens.

Study Design

Type

RCT (n=47)

Blinding

double-blinded

Randomization

randomized

Structured PICO

Does carvedilol alone or in combination with digoxin improve ventricular rate and symptoms compared to digoxin alone in patients with heart failure and persistent atrial fibrillation?

Population

47 patients (mean age 68 years, 38% female) with persistent atrial fibrillation and heart failure (mean LVEF 24%) evaluated over two phases totaling 10 months.

Intervention

Carvedilol in combination with digoxin (4 months) followed by carvedilol alone (6 months)

Comparator

Digoxin alone

Outcome

Ventricular rate on 24-h ambulatory electrocardiographic monitoringsurrogate

Main Result

p-value: p=<0.0001

The combination of carvedilol and digoxin is superior to either agent alone for rate control and improving LVEF in patients with heart failure and persistent atrial fibrillation.

Cite This Study

Khand et al. (2003) conducted an RCT in persistent atrial fibrillation and heart failure (n=47). Carvedilol and digoxin combination therapy vs. Digoxin alone was evaluated on ventricular rate on 24-h ambulatory electrocardiographic monitoring (p=<0.0001). Combination therapy with carvedilol and digoxin lowered ventricular rate (P<0.0001) and improved LVEF compared to digoxin alone in patients with persistent atrial fibrillation and heart failure.

synapsesocial.com/papers/6a90fe1a73d671a805e3bb22 https://doi.org/10.1016/j.jacc.2003.07.020

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Implication

The combination of carvedilol and digoxin is superior to either agent alone for rate control and improving LVEF in patients with heart failure and persistent atrial fibrillation.

Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure?

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure?

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

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