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Ivabradine: Current and Future Treatment of Heart Failure
Lene Thorup1, Ulf Simonsen1, Daniela Grimm1
1Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark.
Insights
Ivabradine effectively lowers heart rate (HR) in heart failure with reduced ejection fraction (HFrEF) patients with HR > 70 bpm, improving outcomes and reducing hospital readmissions. It offers a potential alternative when beta-blockers are not tolerated.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure (HF) impairs cardiac efficiency, increasing mortality risk, especially with elevated heart rate (HR > 70 bpm).
- Current HF with reduced ejection fraction (HFrEF) treatments include ACE inhibitors, AT1 antagonists, beta-blockers, and others.
Purpose of the Study:
- To review the evidence for ivabradine's efficacy in lowering HR in HF patients.
- To assess ivabradine's impact on clinical outcomes in HFrEF.
Main Methods:
- Review of clinical trial data on ivabradine in HFrEF patients.
- Analysis of ivabradine's mechanism of action as an If channel blocker.
Main Results:
- Ivabradine improves ejection fraction (EF) and reduces hospital readmissions in HFrEF, particularly in patients with HR > 70 bpm.
- Adverse effects include bradycardia and atrial fibrillation; it avoids negative inotropic effects.
Conclusions:
- Ivabradine improves outcomes in stable HFrEF (EF < 35%, HR > 70 bpm) and may be a first-choice therapy if beta-blockers are not tolerated.
- Further research is needed to evaluate its efficacy in HF with preserved ejection fraction (HFpEF).
Abstract:
In heart failure (HF), the heart cannot pump blood efficiently and is therefore unable to meet the body's demands of oxygen, and/or there is increased end-diastolic pressure. Current treatments for HF with reduced ejection fraction (HFrEF) include angiotensin-converting enzyme (ACE) inhibitors, angiotension receptor type 1 (AT1 ) antagonists, β-adrenoceptor antagonists, aldosterone receptor antagonists, diuretics, digoxin and a combination drug with AT1 receptor antagonist and neprilysin inhibitor. In HF, the risk of readmission for hospital and mortality is markedly higher with a heart rate (HR) above 70 bpm. Here, we review the evidence regarding the use of ivabradine for lowering HR in HF. Ivabradine is a blocker of an I funny current (I(f)) channel and causes rate-dependent inhibition of the pacemaker activity in the sinoatrial node. In clinical trials of HFrEF, treatment with ivabradine seems to improve clinical outcome, for example improved ejection fraction (EF) and less readmission for hospital, but the effect appears most pronounced in patients with HRs above 70 bpm, while the effect on cardiovascular death appears less consistent. The adverse effects of ivabradine include bradycardia, atrial fibrillation and visual disturbances, but ivabradine avoids the negative inotrope effects observed with β-adrenoceptor antagonists. In conclusion, in patients with stable HFrEF with EF<35% and HR above 70 bpm, ivabradine improves the outcome and might be a first choice of therapy, if beta-adrenoceptor antagonists are not tolerated. Further studies must show whether that can be extended to HF patients with preserved EF.