title: Characterizing patients with chronic heart failure in community care after hospitalization: a potential role for ivabradine.
abstract: OBJECTIVE
  To identify the prevalence and characteristics of recently hospitalized chronic heart failure (CHF) patients in community care who meet the indication for ivabradine.
  
  
  METHODS
  A retrospective clinical audit of CHF patients recently hospitalized with acute decompensated heart failure (ADHF) and subsequently referred to the Tayside Heart Failure Nurse Liaison Service (THFNLS), a Scottish nurse-led community heart failure liaison service. Inclusion criteria were previous hospitalization with ADHF, subsequent referral to the THFNLS, data for ≥ 2 nurse visits, and a recorded pulse. The main outcome measure was the proportion of patients who meet the indicated criteria for ivabradine.
  
  
  RESULTS
  In the UK, ivabradine is indicated for CHF with systolic dysfunction in patients in sinus rhythm, with a heart rate ≥ 75 bpm, and NYHA class II-class IV. After up-titration of a beta-blocker, 19.0% of patients in the full dataset (158 of 830) met the indication for ivabradine at the last visit. Of these "ivabradine-suitable" patients, 101 of 158 (63.9%) received bisoprolol "at any time" during the study period; 20 of 158 (12.7%) achieved the target dose (10 mg daily); 52 of 158 (32.9%) received 5 mg or 7.5 mg daily; and 93 of 158 (58.9%) received <5 mg daily.
  
  
  CONCLUSIONS
  In this group of Scottish patients previously hospitalized with ADHF and under the care of a protocol-driven clinic, 19% met the indication for ivabradine and may benefit from the increased control of CHF that ivabradine can provide. Among these "ivabradine-suitable" patients, <15% achieved the target dose of beta-blockers, illustrating the substantial clinical need for a well-tolerated and effective therapy such as ivabradine.
authors: Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK.
authors: Douglas H
authors: DH
authors: Elder
authors: Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK.
authors: Mohapradeep
authors: M
authors: Mohan
authors: Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK.
authors: Lynda
authors: L
authors: Cochrane
authors: Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK.
authors: Helena
authors: H
authors: Charles
authors: Division of Cardiovascular and Diabetes Medicine and Health Informatics Centre, University of Dundee, Dundee, UK.
authors: Chim C
authors: CC
authors: Lang
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001552:Benzazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D017298:Bisoprolol / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D002985:Clinical Protocols; D004363:Drug Utilization; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D000077550:Ivabradine; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D012189:Retrospective Studies; D006113:United Kingdom
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine; D017298:Bisoprolol
keywords: Beta-blockers; Chronic heart failure; Clinical audit; Healthcare delivery; Heart rate reduction; Ivabradine