Ivabradine, a novel medication for treatment of heart failure with reduced ejection fraction
Jenna L Foster1,2, Rodel V Bobadilla2,3
1Department of Pharmaceutical Services and Clinical Nutrition, Palmetto Health Richland, Columbia, South Carolina.
Insights
Ivabradine effectively reduces hospitalizations in heart failure (HF) patients with reduced ejection fraction and elevated heart rate (HR). This medication is safe and beneficial for specific HF patient populations, primarily by lowering HR.
Area of Science:
- Cardiology
- Pharmacology
- Heart Failure Management
Background:
- Heart failure with reduced ejection fraction (HFrEF) remains a significant cause of morbidity and mortality.
- Heart rate (HR) is a modifiable risk factor in patients with HFrEF.
- Ivabradine offers a novel mechanism for HR reduction.
Purpose of the Study:
- To critically evaluate the current literature on ivabradine.
- To review the pharmacology of ivabradine.
- To discuss the clinical role of ivabradine in patients with HFrEF.
Main Methods:
- A comprehensive PubMed search was conducted using terms 'ivabradine' and 'HF'.
- Evaluation included all human studies of ivabradine in HFrEF patients.
- Prescribing information was also assessed.
Main Results:
- The SHIFT study demonstrated a significant reduction in the composite endpoint of cardiovascular death and HF hospitalizations.
- This benefit was primarily driven by a reduction in hospitalizations for worsening heart failure.
- Bradycardia was the most common adverse effect observed.
Conclusions:
- Ivabradine is a safe and effective option for HR reduction in symptomatic HFrEF patients.
- It is indicated for patients in sinus rhythm with an HR > 70 bpm and ejection fraction < 35%.
- Ivabradine significantly reduces hospitalizations in this specific heart failure population.
Purpose:
To critically evaluate current literature, review pharmacology, and discuss clinical role of ivabradine for patients with heart failure (HF) with reduced ejection fraction.
Data Sources:
A PubMed search was conducted using the search terms ivabradine and HF. All human studies analyzing the use of ivabradine in patients with HF with reduced ejection fraction and prescribing information were evaluated.
Conclusions:
Greater benefit was seen in the prespecified subgroup with heart rate (HR) > 70 beats per minute (bpm) in the BEAUTIFUL study. Therefore, SHIFT examined the effect of ivabradine on patients with higher resting HR, lower ejection fraction, who had been hospitalized for HF within the previous year. A significant difference was found in the composite primary endpoint of cardiovascular death and hospitalizations for worsening HF in patients with HF and left ventricular systolic dysfunction, driven primarily by reduction in hospitalizations for worsening HF. The most common adverse effect was bradycardia.
Implications For Practice:
Ivabradine is a safe and effective medication for HR reduction to reduce hospitalizations in patients with stable, symptomatic HF (ejection fraction < 35%), in sinus rhythm, and HR > 70 bpm.
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