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The effect of ivabradine therapy on heart failure patients with reduced ejection fraction: a systematic review and

Camila Hartmann1, Natasha Ludmila Bosch1, Luara de Aragão Miguita1

  • 1Pontificia Universidade Católica do Paraná, Curitiba, Brazil.

International Journal of Clinical Pharmacy
|September 3, 2018
PubMed

Insights

Ivabradine effectively lowers heart rate in Heart Failure with Reduced Ejection Fraction (HFrEF) patients. However, this study found no significant impact on mortality or heart failure hospitalizations beyond beta-blocker therapy.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Ivabradine is indicated for Heart Failure with Reduced Ejection Fraction (HFrEF).
  • Its additional benefits beyond beta-blockers require clarification.

Purpose of the Study:

  • To evaluate the supplementary effects of ivabradine on cardiovascular death, all-cause mortality, heart failure hospitalization, and heart rate in HFrEF patients.
  • To assess ivabradine's impact independent of beta-blocker therapy.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials comparing ivabradine to a control group.
  • Searches conducted up to June 2016, pooling relative risks (RRs) and 95% confidence intervals (CIs).
  • Heterogeneity assessed using the I-squared statistic.

Main Results:

  • Seven trials involving 17,747 patients were included; risk of bias was high for low beta-blocker doses.
  • Ivabradine showed no significant effect on all-cause mortality (RR 0.98, 95% CI 0.90-1.06), cardiovascular death (RR 0.99, 95% CI 0.91-1.08), or HF hospitalization (RR 0.87, 95% CI 0.68-1.12).
  • Heart rate decreased by 8.7 bpm (95% CI 6.37-11.03); this effect was less pronounced with recommended beta-blocker doses (4.70 bpm).

Conclusions:

  • Ivabradine significantly reduces heart rate in HFrEF patients, with a greater effect when beta-blocker doses are suboptimal.
  • No significant additional benefits were observed for mortality or heart failure hospitalizations.
  • Conclusions were limited by high bias and unreported beta-blocker dosages.

Keywords:
Beta-blockersHeart failureHeart rateIvabradineLeft ventricular dysfunctionSystematic review

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