title: Beta-blockers and ivabradine in chronic heart failure: from clinical trials to clinical practice.
abstract: Beta-blockers have become one of the cornerstones of treatment of patients with heart failure (HF) and depressed left ventricular function, but in clinical practice only 30-35% of patients achieve the therapeutic target dose as established in randomized clinical trials. Moreover, high resting heart rate (HR) has emerged as a simple but relevant risk factor for cardiovascular events, including coronary artery disease and HF; also, it was found to have an independent prognostic value in patients with HF. Evidence that HR could be considered a good parameter to evaluate the quality of treatment in patients with HF has been suggested; of note, many patients maintain a resting HR ≥70 beats per minute despite optimal beta-blocker therapy. In recent years, a new drug able to reduce HR, ivabradine, has been introduced in clinical practice, and its use in the clinical setting of HF patients has been recommended by current European Society of Cardiology (ESC) guidelines. Here we review the evidence of the prognostic role of HR in systolic HF and the potential relationship between HR lowering and the beneficial effects of beta-blockers; we will also analyze the reasons why an appropriate use of these drugs is seldom achieved in clinical practice, and review the evidence for the use of ivabradine in systolic HF in the clinical setting.
authors: Department of Cardiovascular Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Antonino
authors: A
authors: Di Franco
authors: Filippo M
authors: FM
authors: Sarullo
authors: Ylenia
authors: Y
authors: Salerno
authors: Stefano
authors: S
authors: Figliozzi
authors: Rossella
authors: R
authors: Parrinello
authors: Pietro
authors: P
authors: Di Pasquale
authors: Gaetano A
authors: GA
authors: Lanza
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D054143:Heart Failure, Systolic / Q000188:drug therapy / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D000077550:Ivabradine; D013318:Stroke Volume / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D001552:Benzazepines; D000077550:Ivabradine