title: Ivabradine improves quality of life in subjects with chronic heart failure compared to treatment with β-blockers: results of a multicentric observational APULIA study.
abstract: OBJECTIVE
  Ivabradine (IVA), a selective If current inhibitor decreasing the heart rate (HR) in patients with sinus rhythm, has been added to the most recent European Guidelines on heart failure. This selective treatment reduces HR exclusively while fully preserving myocardial contractility and relaxation, atrioventricular conduction, and ventricular repolarization, as well as blood pressure. The aim of this study was to evaluate the improvement of quality of life (QOL) in patients with chronic heart failure (CHF) treated with IVA versus two β-blockers (bisoprolol and carvedilol).
  
  
  METHODS
  We evaluated if a 1-month treatment with IVA (5 mg b.i.d.) or β-blockers (carvedilol 6.25 mg b.i.d. or bisoprolol 1.25 mg b.i.d.) improves the QOL (assessed by SF-36 questionnaire) in patients with CHF with reduced left ventricular ejection fraction (<50%). SF-36 was tested in 221 CHF patients (mean age 64 ± 6 years) randomized into two groups (IVA group - 110 patients; β-blockers group - 111 patients). Data of QOL questionnaire and HR were collected by an interview during a clinical visit both at prescription time (basal) and after 1 month of therapy with IVA or β-blockers. QOL life and HR results after 1-month of therapy (T1) with IVA were compared with basal values (T0).
  
  
  RESULTS
  The IVA versus β-blockers treatment was associated with a significant improvement of physical functioning (p < 0.001 vs. p < 0.01), physical role functioning (p < 0.001 vs. p < 0.01), emotional role functioning (p < 0.01 vs. p < 0.85), and mental health scales (p < 0.001 vs. p < 0.01). HR in the IVA group was significantly lower compared to the group of patients treated with β-blockers (63 vs. 67 bpm; p < 0.001).
  
  
  CONCLUSIONS
  IVA treatment significantly improves the QOL in patients with CHF without any deleterious impact on hemodynamics, and may be beneficial in these patients without other adverse effects associated with β-blockers.
authors.affiliation: Cardiology Unit, San Camillo del Lellis Hospital, Manfredonia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Riccioni
authors.forename: L
authors.initials: L
authors.lastname: Masciocco
authors.forename: A
authors.initials: A
authors.lastname: Benvenuto
authors.forename: P
authors.initials: P
authors.lastname: Saracino
authors.forename: D
authors.initials: D
authors.lastname: De Viti
authors.forename: F
authors.initials: F
authors.lastname: Massari
authors.forename: G
authors.initials: G
authors.lastname: Meliota
authors.forename: F
authors.initials: F
authors.lastname: Buta
authors.forename: G
authors.initials: G
authors.lastname: Speziale
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use; D017298:Bisoprolol / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002227:Carbazoles / Q000009:adverse effects / Q000627:therapeutic use; D000077261:Carvedilol; D002908:Chronic Disease; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D000077550:Ivabradine; D011412:Propanolamines / Q000009:adverse effects / Q000627:therapeutic use; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D001552:Benzazepines; D017298:Bisoprolol; D002227:Carbazoles; D000077261:Carvedilol; D000077550:Ivabradine; D011412:Propanolamines