Ivabradine for treatment of heart failure

ABSTRACT

Introduction: Heart failure with reduced ejection fraction (HFrEF) is associated with a worse outcome. Heart rate (HR) is related to outcome in HFrEF. Ivabradine selectively inhibits I_f (funny) channels in a concentration-dependent manner reducing HR.

Areas covered: The effects of ivabradine in HF were reviewed. The SHIFT trial results indicated that ivabradine improves chronic HFrEF outcomes, whereas published data suggest that amiodarone, digoxin, or verapamil may not be safe or the safety is controversial in HFrEF patients. In the CONSTATHE-DHF study, ivabradine reduced HR and improved left ventricular (LV) ejection fraction, LV diastolic functions, and right ventricle function in acute decompensated HF (ADHF). In chagasic patients, ivabradine reduced HR and a trend toward reduction in all-cause death was observed with ivabradine (p = 0.07). In children with HFrEF, ivabradine increased NYHA functional class. The most common side effects with ivabradine are bradycardia, atrial fibrillation, and phosphenes. Ivabradine was approved for HFrEF treatment by the EMA and FDA and seems to be cost-effective in HFrEF treatment. Ivabradine is indicated for HFrEF by the ESC HF Guidelines (IIa) and by the 2016 ACC/AHA/HFSA Guidelines (IIa-B-R).

Expert opinion: Published evidences demonstrate that ivabradine improves the outcome of chronic HFrEF and it seems to have a promising role in ADHF.

KEYWORDS:

• Heart failure
• decompensated heart failure chronic heart failure
• ivabradine
• prognosis
• heart rate
• Chagas disease
• cost-effectiveness

Article highlights

• Heart failure (HF) is an important burden for health systems because of high mortality, high rate of hospitalization, and the cost for management.

• Increased heart rate is a risk factor for events in HF with reduced left ventricular ejection fraction (HFrEF).

• Ivabradine selectively inhibits I_f (funny) channels in a concentration-dependent manner reducing HR.

• Ivabradine reduced combined end point of cardiovascular death or hospital admission for worsening HFrEF (SHIFT trial).

• Ivabradine may be a promising medication for acute HF in the setting of high HR.

This box summarizes key points contained in the article.

Declaration of interest

EA Bocchi has received consulting fees from Servier, and Astra-Zeneca and subsidized travel/hotel/registration fees from Servier, Novartis and Baldacci. EA Bocchi is a member of steering committees for Servier, Novartis and Bayer, and has been contracted to research for Jansen, Bayer/Merck and Boehringer Ingelheim. EA Bocchi has received honoraria from Servier and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.