Ivabradine for stable angina?

Up to 1 in 25 people in Europe and the USA have stable angina, with symptoms that may limit function and quality of life. Beta-blockers are usually used in initial symptomatic treatment, but may cause unwanted effects. They are also contraindicated in some patients (e.g. those with uncontrolled heart failure, severe peripheral vascular disease) and should be avoided in patients with asthma or a history of reversible obstructive airways disease or bronchospasm. Ivabradine (Procoralan-Servier) is the first in a new class of specific heart rate-reducing drugs and is licensed for the "symptomatic treatment of chronic stable angina pectoris in patients with normal sinus rhythm, who have a contra-indication or intolerance for beta-blockers". Here we consider the place of ivabradine in the management of patients with stable angina.