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Limited role for ivabradine in the treatment of chronic heart failure
  1. Damien Cullington,
  2. Kevin M Goode,
  3. John G F Cleland,
  4. Andrew L Clark
  1. Department of Cardiology, Postgraduate Medical Institute, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
  1. Correspondence to Professor Andrew L Clark, Division of Cardiovascular and Respiratory Studies, Post graduate Medical Institute, 1st Floor, MRTDS Building, Castle Hill Hospital, Cottingham, Kingston-Upon-Hull HU16 5JQ, UK; a.l.clark{at}hull.ac.uk

Abstract

Objective To quantify the proportion of patients attending a community heart failure clinic with left ventricular systolic impairment who might be suitable for ivabradine therapy.

Background High resting heart rate is an important and potentially modifiable risk factor in patients with heart failure. The SHIFT study suggested that ivabradine was beneficial when added to conventional treatment including a β-blocker in heart failure patients in sinus rhythm whose resting heart rates remained 70 beats per minute (bpm) or greater and who had worse than moderate left ventricular impairment.

Methods and Results The primary cohort included 2211 patients with a left ventricular ejection fraction (LVEF) of 50% or less. Patients were seen at baseline, then reviewed at 4 and 12 months. ‘Suitability’ for ivabradine was assessed as: LVEF 35% or less, sinus rhythm and a resting heart rate of 70 bpm or greater. The proportion of patients who were ‘suitable’ for ivabradine therapy fell from 19.4% (n=429) at baseline, to 14.1% (n=185) at 4 months and finally 9% (n=82) by the 12-month clinic visit. The proportion fell to 5.3% (n=48) if only patients with New York Heart Association class I symptoms and/or no β-blocker therapy were excluded.

Conclusions After uptitration of heart failure medications, the number of patients ‘suitable’ for ivabradine therapy was small. First and foremost, β-blocker therapy should be commenced and titrated. The decision to add ivabradine should be made after allowing adequate time to uptitrate conventional medical therapy.

  • Antiplatelet treatment
  • atrial fibrillation
  • β-blocker
  • biochemical markers
  • cardiomyopathy dilated
  • chronic heart failure
  • clinical heart failure
  • clinical trials
  • diagnosis
  • diagnostic methods
  • digitalis
  • EBM
  • echocardiography
  • exercise physiology
  • heart failure
  • heart failure treatment
  • heart rate
  • ivabradine
  • LV dysfunction
  • natriuretic peptides
  • oral anticoagulants
  • randomised trials
  • renin–angiotensin system
  • screening
  • sudden cardiac death

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Footnotes

  • Correction notice This article has been corrected since it was published Online First. The title has been modified by request of the authors.

  • Competing interests DC, JGFC and ALC have received honoraria from Servier, which produces the drug ivabradine.

  • Ethics approval Ethics approval was provided by Hull and East Yorkshire REC.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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