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Role of ivabradine and heart rate lowering in chronic heart failure: guideline update
Sheryl L Chow1, Robert L Page2, Christophe Depre3
1a Department of Pharmacy , Western University of Health Sciences , Pomona , CA , USA.
Insights
Heart rate lowering agents, like ivabradine, may benefit select heart failure patients. Ivabradine reduced cardiovascular death or hospitalizations in a phase III trial when added to standard therapy.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure (HF) with reduced ejection fraction requires optimized management.
- Current guidelines are updated to include new therapeutic strategies.
Purpose of the Study:
- To review the current management of HF with reduced ejection fraction.
- To evaluate the role of heart rate lowering agents, specifically ivabradine, in select HF populations.
Main Methods:
- A PubMed search was conducted for studies on heart rate lowering agents or ivabradine in HF management.
- Review of clinical data from a phase III trial assessing ivabradine's efficacy and safety.
Main Results:
- Ivabradine targets the sinoatrial node's funny current (If), reducing heart rate without impacting cardiac contractility.
- A phase III trial showed ivabradine significantly reduced the composite endpoint of cardiovascular death or HF hospital admission.
- Ivabradine demonstrated an acceptable safety profile when used with standard HF therapies.
Conclusions:
- Heart rate targeting with agents like ivabradine may provide additional benefits when combined with standard HF treatments.
- Ivabradine is a promising option for select patients with chronic HF, particularly after optimizing existing therapies.
Introduction:
This review summarizes the current management of heart failure (HF) in patients with reduced ejection fraction and the potential role of heart rate lowering agents in select populations, as recommended in the updated guidelines. Areas covered: PubMed was searched for studies that evaluated the role of heart rate lowering or ivabradine in HF management. Expert commentary: Targeting heart rate may offer benefit when added to renin-angiotensin aldosterone antagonists, and beta-blockers. Ivabradine is a heart rate lowering agent that acts on the funny current (If) in the sinoatrial node, thereby reducing heart rate without directly affecting cardiac contraction and relaxation. Clinical data from a phase III trial demonstrated that ivabradine reduced the composite end point of cardiovascular death or hospital admission for worsening systolic HF, while maintaining an acceptable safety profile in patients receiving standard of care therapy. These data, in addition to more recently published guidelines, suggest ivabradine as a promising new treatment option for lowering heart rate after optimizing standard therapy in select patients with chronic HF.
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