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Heart rate treatments could be used to improve heart function

Study reveals digoxin improves heart pump function and helps ease heart failure and atrial fibrillation symptoms.

24 September 2025
A heart lying on top of an electrocardiogram reading

A recent study by Birmingham researchers, delivered through the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), has shown that treatments used to control heart rate could be used to help heart function in patients with atrial fibrillation and heart failure.

Atrial fibrillation is a common heart condition that leads to an irregular and often rapid heart rate. Atrial fibrillation can reduce heart function, resulting in patients developing a condition known as heart failure. Heart failure happens when the heart either doesn’t pump or relax as well as it should. As a result, the body does not receive enough oxygen, causing patients to develop symptoms such as breathlessness, dizziness and swelling in their feet and ankles. The number of patients with both atrial fibrillation and heart failure is increasing exponentially, making it important to define effective therapies.

Heart rate treatments

Recently, a team of researchers from Birmingham carried out the RATE-AF trial, funded by the NIHR, which compared two treatments used to control heart rate, called beta-blockers and digoxin. This trial revealed that digoxin led to fewer adverse events, including lower rates of hospital admission and general practice reviews for heart health. Digoxin was also found to have greater cost-effectiveness.

Researchers have carried out a sub-study within the original trial, investigating whether there was a difference in how these two treatments affected heart function specifically.

Effectiveness for heart function

The 160 patients who participated in the randomized study were either given digoxin or a beta-blocker called bisoprolol daily on a 1:1 ratio. They all had an ultrasound scan of the heart, called an echocardiogram, before starting their treatment and subsequently after 12 months of their treatment. This measured how well the heart pumped and relaxed at each of these points.

This study supports the use of low-dose digoxin in this patient group to improve heart function with a greater improvement seen in patients with heart failure and a preserved ejection fraction.

Dr Karina Bunting, British Heart Foundation Career Development Research Fellow, University of Birmingham

The results of the study revealed that digoxin improved heart pump function in all patients with atrial fibrillation and heart failure. In patients whose atrial fibrillation and heart failure was caused by a heart which is unable to relax normally, digoxin was found to improve the pump function of the heart more than beta-blockers. Additionally, digoxin was found to cause fewer side effects than beta-blockers and improved symptoms related to atrial fibrillation and heart failure to a greater extent.

Dr Karina Bunting, British Heart Foundation Career Development Research Fellow at the University of Birmingham, and a researcher within the NIHR Birmingham BRC Thrombo-inflammation research theme, said: “There is limited data to guide doctors on what treatment to give patients with atrial fibrillation and heart failure, particularly in those with a preserved ejection fraction.

“This study supports the use of low-dose digoxin in this patient group to improve heart function with a greater improvement seen in patients with heart failure and a preserved ejection fraction, alongside improvement in symptoms, reduced strain on the heart and significantly fewer adverse events when compared to beta-blockers.”

Researchers hope that the results of the study may continue to inform future treatment for patients with atrial fibrillation and heart failure.

Notes for editors

For media enquiries please contact Tim Mayo, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.

Notes to editor:

  • The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, educators and more than 40,000 students from over 150 countries.
  • England’s first civic university, the University of Birmingham is proud to be rooted in of one of the most dynamic and diverse cities in the country. A member of the Russell Group and a founding member of the Universitas 21 global network of research universities, the University of Birmingham has been changing the way the world works for more than a century.
  • The University of Birmingham is committed to achieving operational net zero carbon. It is seeking to change society and the environment positively, and use its research and education to make a major global contribution to the UN Sustainable Development Goals. Find out at birmingham.ac.uk/sustainability.
  • The University of Birmingham is a founding member of Birmingham Health Partners (BHP), a strategic alliance which transcends organisational boundaries to rapidly translate healthcare research findings into new diagnostics, drugs and devices for patients. Birmingham Health Partners is a strategic alliance between nine organisations who collaborate to bring healthcare innovations through to clinical application:
  • University of Birmingham
  • University Hospitals Birmingham NHS Foundation Trust
  • Birmingham Women’s and Children’s Hospitals NHS Foundation Trust
  • Aston University
  • The Royal Orthopaedic Hospital NHS Foundation Trust
  • Sandwell and West Birmingham Hospitals NHS Trust
  • Health Innovation West Midlands
  • Birmingham and Solihull Mental Health NHS Foundation Trust
  • Birmingham Community Healthcare NHS Foundation Trust

About the National Institute for Health and Care Research

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

  • Funding high quality, timely research that benefits the NHS, public health and social care;
  • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
  • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
  • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
  • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

 

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK international development funding from the UK government.

https://www.nihr.ac.uk/

 

The NIHR Birmingham Biomedical Research Centre (BRC) is part of the NIHR and hosted by University Hospitals Birmingham NHS Foundation Trust (UHBFT) in partnership with the University of Birmingham (UoB). The BRC’s research programme focuses on inflammation and the diagnosis, prevention and treatment of its associated long-term illnesses.

Featured staff

  • Dr Karina V Bunting

    British Heart Foundation Fellow

    Staff profile of Dr Karina Bunting, British Heart Foundation Fellow, at Cardiovascular Sciences (CVS), University of Birmingham.

    Phone: +44 (0)121 3712550 (cardiology)
    Email:

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