title: Ivabradine in combination with beta-blocker reduces symptoms and  improves quality of life in elderly patients with stable angina pectoris:  age-related results from the ADDITIONS study.
abstract: BACKGROUND
  Clinical trials have proven the anti-anginal and anti-ischemic efficacy of the pacemaker current inhibitor ivabradine in combination with beta-blockers in patients with stable angina pectoris (AP). This retrospective subgroup analysis of the ADDITIONS study evaluated the effectiveness and tolerability of ivabradine combined with beta-blockers, and its effects on angina symptoms and quality of life in elderly patients ≥ 75 years in everyday practice.
  
  
  METHODS
  In the non-interventional, multicenter, prospective, open-label ADDITIONS study 2330 patients with stable AP of different age groups were treated with a flexible dose of ivabradine twice daily in addition to beta-blockers for 4 months. Heart rate (HR), number of angina attacks, nitrate consumption, tolerance, and quality of life (QoL) were evaluated. A subgroup analysis was performed, focusing on 479 patients (21%) ≥ 75 years.
  
  
  RESULTS
  In these 479 patients ≥ 75 years ivabradine (mean dose 11.61 ± 3.18 mg per day) after 4 months of treatment reduced HR by 19.2 ± 11.6 bpm to 65.4 ± 8.3 bpm. The average number of angina attacks per week was decreased by 1.6 ± 1.8 to 0.4 ± 1.3 and the average consumption of short-acting nitrates per week was reduced by 2.2 ± 3.2 to 0.6 ± 1.8 units (both p < 0.0001). There was a marked shift in Canadian Cardiovascular Society (CCS) grade distribution with most patients (57%) now classified as CCS grade I, and 42% as CCS grades II and III. This was accompanied by an improvement in EQ-5D QoL index to 0.75 ± 0.22 (p < 0.0001). Tolerability of ivabradine treatment was rated by the physicians as “very good/good” for 72%/28% of elderly patients.
  
  
  CONCLUSIONS
  In daily clinical practice, addition of ivabradine to beta-blockers was effective in reducing HR, angina attacks and nitrate consumption in elderly patients (≥ 75 years) with stable angina pectoris. In addition, a marked improvement of CCS symptom scores and QoL was demonstrated. Treatment was generally well tolerated.
authors.forename: Ursula
authors.initials: U
authors.lastname: Müller-Werdan
authors.forename: Georg
authors.initials: G
authors.lastname: Stöckl
authors.forename: Henning
authors.initials: H
authors.lastname: Ebelt
authors.forename: Sebastian
authors.initials: S
authors.lastname: Nuding
authors.forename: Florian
authors.initials: F
authors.lastname: Höpfner
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D000077550:Ivabradine; D008297:Male; D009566:Nitrates / Q000008:administration & dosage; D011594:Psychometrics; D011788:Quality of Life; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D001552:Benzazepines; D002317:Cardiovascular Agents; D009566:Nitrates; D000077550:Ivabradine