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Heart Rate Reduction and the Prognosis of Heart Failure Focused on Ivabradine

Shunsuke Kiuchi1, Takanori Ikeda1

  • 1Department of Cardiovascular Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.

Journal of Clinical Medicine
|February 26, 2025
PubMed

Insights

Ivabradine is a heart failure medication that reduces heart rate (HR), improving stroke volume and exercise tolerance in patients with heart failure with reduced ejection fraction (HFrEF). It is indicated only for HFrEF patients, not HFpEF.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Elevated heart rate (HR) is a significant prognostic factor in heart failure (HF) patients and the general population.
  • In heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), elevated HR correlates with all-cause mortality.
  • Cardiovascular death is specifically linked to elevated HR in HFrEF patients.

Purpose of the Study:

  • To review the role of ivabradine in managing heart failure (HF).
  • To highlight the specific indications and benefits of ivabradine in HFrEF.
  • To discuss the impact of ivabradine on stroke volume, exercise tolerance, and potential side effects.

Main Methods:

  • Review of clinical trials and existing literature on ivabradine in HF treatment.
  • Analysis of ivabradine's effects on heart rate, stroke volume, and patient outcomes.
  • Comparison of ivabradine's efficacy in HFrEF versus HFpEF.

Main Results:

  • Ivabradine is effective in HFrEF but not HFpEF, indicated for elevated HR in HFrEF.
  • Ivabradine decreases HR, increasing stroke volume and diastolic time, potentially allowing reduction of other HF medications.
  • Ivabradine improves exercise tolerance and HF symptoms, though further research is ongoing. Reported side effects include photopsia and atrial fibrillation.

Conclusions:

  • Ivabradine is a valuable therapeutic option for HFrEF patients with elevated HR.
  • Appropriate use of ivabradine alongside standard HF therapies, including quadruple therapy, is crucial.
  • Ongoing research aims to further elucidate the effects of ivabradine on exercise tolerance in HF.

Keywords:
exercise toleranceheart failureheart rateivabradine

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