title: Pathophysiologic Insights into Heart Rate Reduction in Heart Failure: Implications in the Use of Beta-Blockers and Ivabradine.
abstract: In patients with heart failure, an elevated heart rate is associated with worse cardiovascular outcomes and is increasingly recognized as a modifiable risk factor. Beta-blockers are the mainstay of therapy for heart failure. However, up-titration of beta-blockers in response to persistently elevated heart rate can be associated with increased risk of adverse reactions besides negative chronotropism. Recently, the specific heart rate-lowering agent, ivabradine, which acts by directly and selectively inhibiting the I f current in the sinoatrial node, generated renewed interest in potential benefits of pharmacologic modification of heart rate in heart failure. Several placebo-controlled, multicenter clinical trials showed the benefits of ivabradine in patients with angina and heart failure, which is largely confined to those with left ventricular systolic dysfunction. In addition, the other potential effects of ivabradine have been proposed.
authors.affiliation: Kaufman Center for Heart Failure, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue Desk J3-4, Cleveland, 44195, OH, USA.|Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimanakamachi Chuo-ku, Kobe, 650-0047, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kitai
authors.affiliation: Kaufman Center for Heart Failure, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue Desk J3-4, Cleveland, 44195, OH, USA. tangw@ccf.org.|Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH, USA. tangw@ccf.org.
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
keywords: Clinical trials; Heart failure; Heart rate; Heart rate reduction; Ivabradine
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