Ivabradine for the treatment of chronic heart failure

ABSTRACT

Several studies have underlined the beneficial effects of a lower heart rate on mortality in patients with chronic heart failure and reduced ejection fraction. In clinical practice, achieving a heart rate ≤70 bpm with beta-blockers is not always possible. In this context, the more recent guidelines added ivabradine to the management of those patients if heart rate remains ≥70 bpm in sinus rhythm and symptoms persist despite treatment with an evidence-based or maximum tolerated dose of a beta-blocker, an angiotensin converting enzyme inhibitor or angiotensin-receptor blocker, and a mineralocorticoid receptor antagonist. Ivabradine is a well-tolerated, safe and effective treatment option with the objective to improve prognosis, left ventricular structure and function, exercise tolerance and quality of life. Accordingly, the following article will evaluate the benefits of a combination of the currently recommended pharmacological therapy in chronic heart failure with the selective heart rate reducing agent ivabradine.

KEYWORDS:

• Ivabradine
• heart failure
• heart rate reduction
• beta-blockers
• left ventricular function
• exercise tolerance
• quality of life

Declaration of interest

E O’Meara has received research grants and honoraria for Novartis and Servier. S de Denus has received research grants supported by AstraZeneca, Roche, Novartis and Pfizer; speaker fees from Pfizer; and consulting fees from Servier and Novartis. JC Tardif has received research grants and honoraria for Servier. 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.