Digoxin is no longer the first choice for the treatment of HFrEF, even though it may be considered in symptomatic HF patients with sinus rhythm despite treatment with an ACE inhibitor (or ARB), a beta-blocker, and an MRA, to reduce the risk of hospitalization, or in patients with high-rate atrial fibrillation [68]. Here, ACE is linked to atrial fibrillation.