Heart failure: ivabradine is no better than optimised beta-blocker therapy

In a double-blind randomised placebo-controlled trial including about 6500 heart failure patients, ivabradine did not reduce overall mortality or cardiovascular mortality. Ivabradine reduced mortality due to heart failure, but not in the subgroup of patients receiving at least half the recommended dose of a beta-blocker. In a double-blind randomised placebo-controlled trial in about 10 000 patients with coronary artery disease and heart failure, ivabradine had no tangible efficacy. Treatment withdrawals were more frequent with ivabradine than in the placebo arms of these trials. Adverse effects included bradycardia and visual disorders. In practice, beta-blockers used at optimal doses have documented efficacy in heart failure patients. This is not the case for ivabradine, and its adverse effects have been confirmed.