The use of beta-blockers or rate-limiting calcium-channel blockers for initial rate-control treatment was retained by the committee because this is current practice and there was insufficient evidence to suggest an alternative option. The committee agreed that the choice of treatment should still be made based on the symptoms, heart rate, comorbidities and preferences of those being treated. The committee agreed that the recommendations should refer to NICE's guideline on chronic heart failure for advice on using beta-blockers and avoiding rate-limiting calcium-channel blockers such as diltiazem and verapamil in people who have atrial fibrillation with heart failure. The committee agreed that digoxin monotherapy for non-paroxysmal atrial fibrillation should continue to be considered for people who are sedentary. Based on their experience, the committee agreed that it may also be considered as a treatment option when other rate-limiting drugs are not suitable, so they expanded the recommendation in the previous guideline to also cover these circumstances. The committee were aware that some clinicians feel that digoxin monotherapy is often better than alternatives for improving symptoms; however, the lack of evidence currently available meant that the recommendation for digoxin was not expanded to cover further groups of people. In the absence of new evidence, the committee also agreed with the existing recommendation for combination therapy options if initial monotherapy fails, which is consistent with the committee's experience and current practice. There was a lack of evidence on long-term rate control, and the committee were aware of numerous serious side effects associated with the long-term use of amiodarone (including thyroid, lung and nerve damage), many of which are irreversible. The committee noted that although the most common side effects were less severe, the occurrence of severe side effects was unpredictable and long-term rate control with amiodarone should be avoided. 