Reshaping the treatment of atrial fibrillation for improved patient outcomes and cost savings for the NHS 

Atrial fibrillation (AF) affects >1.5million people in the UK. It is a major cause of preventable stroke, heart failure and dementia, costing around 2% of the annual NHS budget.  

AF impacts on patient quality of life, with reduced functional capacity often worsened with other comorbidities.  Patients with AF are typically older with multiple co-morbidities, and over half will have/develop heart failure symptoms.   

An important component of AF treatment is the control of rapid heart rates, which can be achieved with different medications.  However, there was a lack of evidence for the best rate-controlling drugs, making it difficult to choose the right medication for individual patients.  This leads to side effects and contributes to reduced quality of life in AF patients. 

Professor Dipak Kotecha and team have previously provided evidence to inform optimal treatment for older patients with permanent AF and symptoms of heart failure, showing improvement in functional capacity and less adverse events using low-dose digoxin compared to standard-of-care beta-blocker therapy (The RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) trial). This work has been cited in at least 6 international clinical practice guidelines.

A health economic analysis supported by the NIHR Biomedical Research Centre: Birmingham also showed that digoxin costed less than the standard of care conventional first-line beta-blocker therapy, with £102 million potential annual savings for the NHS.