Effects of digoxin with metoprolol or diltiazem on patients with chronic heart failure and chronic atrial fibrillation

Objective To compare the short-term effects and long-term prognosis of digoxin with metoprolol or diltiazem on patients with chronic heart failure (CHF) and chronic atrial fibrillation (AF). Methods Eighty-one patients with CHF and AF were randomly divided into metoprolol treatment group (42 cases) and diltiazem treatment group (39 cases).The general therapy included digoxin, diuretics,angiotensin-converting enzyme inhibitors(ACEI) and anticoagulants. Metoprolol (12.5～50.0 mg/d) and diltiazem (45～90 mg/d) were added to metoprolol group and diltiazem group respectively. The short-term effects in 1 month and the rehospitalization rate and the mortality rate within 2 years were compared between the two groups. Results (1) The ventricular rate at rest (HR) and the diversity of ventricular rate before and after walk(HD) decreased significantly in both two groups( P 0.01),the stroke volume(SV) and the distance of 6-minute walk(S)increased significantly ( P 0.05) and the NYHA heart function classes improved obviously ( P 0.01) in both two groups 1 month after treatment. There was no significant difference between the two groups ( P 0.05) ;(2)The rehospitalization rate was 52.38% in the metoprolol group and 76.92% in diltiazem group( P 0.025) because of deterioration in heart function within 2 years. The mortality rate was 38.10% in the metoprolol group and 61.54% in diltiazem group( P 0.05) for a 2-year follow-up period;(3)After 2 years, the heart function did not change significantly in metoprolol group( P 0.05)but deteriorated in diltiazem group( P 0.05). Conclusion Based on the medication of diuretics,ACEI and anticoagulants,both digoxin with metoprolol and with ditiazem therapy could improve the short-term effects on patients with CHF and AF,but the long-term prognosis of digoxin with metoprolol therapy is better than that of digoxin with diltiazem therapy in patients with CHF and AF.