Initiating ivabradine during hospitalization in patients with acute heart failure: A real-world experience in China
Ying-Xian Liu1, Wei Chen1, Xue Lin1
1Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
Insights
Ivabradine treatment in acute heart failure (HF) patients improved cardiac function and reduced rehospitalization. This study suggests ivabradine is effective for stable acute HF, lowering heart rate and improving outcomes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- The use of ivabradine in acute heart failure (HF) remains a subject of debate.
- Ivabradine may offer benefits when added to treatment for acute, hemodynamically stable HF patients.
Purpose of the Study:
- To evaluate the efficacy and safety of ivabradine in hemodynamically stable acute HF patients.
- To assess the impact of ivabradine on mortality, rehospitalization, heart rate, cardiac function, and adverse events.
Main Methods:
- Retrospective cohort study of 126 hemodynamically stable acute HF patients (Jan 2018-July 2020).
- Comparison of outcomes between patients treated with and without ivabradine.
- Primary endpoints: all-cause mortality and HF rehospitalization. Secondary endpoints: heart rate, NYHA class, LVEF, and adverse events.
Main Results:
- Ivabradine treatment led to significant improvements in NYHA class and LVEF compared to the control group.
- Patients on ivabradine showed a significant reduction in HF rehospitalization (25.4% vs. 61.9%) and longer event-free survival.
- Ivabradine was associated with a negative impact on primary endpoints (HR: 0.51, 95% CI: 0.28-0.91).
Conclusions:
- Ivabradine significantly reduces heart rate in acute, hemodynamically stable HF.
- Treatment with ivabradine improves cardiac function and reduces rehospitalization rates for HF.
- Ivabradine appears to be a beneficial addition to standard therapy for select acute HF patients.
Background:
Initiating ivabradine in acute heart failure (HF) is still controversial.
Hypothesis:
Ivabradine might be effective to be added in acute but hemodynamically stable HF.
Methods:
A retrospective cohort of hemodynamically stable acute HF patients was enrolled from January 2018 to January 2020 and followed until July 2020. The primary endpoints were all-cause mortality and rehospitalization for HF. Secondary endpoints included heart rate (HR), cardiac function measured by New York Heart Association (NYHA) class, and left ventricular ejection fraction (LVEF) and adverse events, which were compared between patients with or without ivabradine.
Results:
A total of 126 patients were enrolled (50 males, median age 54 years, 81% with decompensated HF, median follow-up of 9 months). In patients treated with ivabradine, although baseline HRs were higher than the reference group (96 vs. 80 bpm), they were comparable after 3 months; more patients tolerated high doses of β-blockers (27% vs. 7.9%), improved to NYHA class I function (55.6% vs. 23.8%) and exhibited normal LVEFs (37.8% vs. 14.3%) than the reference group (all p < .05). Ivabradine was associated with a significant reduction of rehospitalization for HF than the reference group (25.4% vs.61.9%), with longer event-free survival times (hazard ratio: 0.45, 95% confidence interval [CI]: 0.25-0.79), and was related with primary endpoints negatively (hazard ratio 0.51, 95% CI: 0.28-0.91) (all p < .05).
Conclusion:
In patients with acute but hemodynamically stable HF, ivabradine may significantly reduce HR, improve cardiac function, and reduce HF rehospitalization.
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