Clinical Experience with Ivabradine in Acute Heart Failure.
OBJECTIVE
Ivabradine has been shown to improve symptoms and to reduce rehospitalization and mortality in patients with severe chronic heart failure (HF). Its indication in acute HF is not clear. Acute HF patients could also benefit from HR reduction, as myocardial consumption and oxidative stress are related to tachycardia. Moreover, beta-blockers are contraindicated in cardiogenic shock and should not be initiated with congestive signs. Accordingly, we evaluated the role of ivabradine in acute HF patients.


METHODS
This was a retrospective analysis of 29 consecutive patients treated for acute HF in the Cardiac ICU, and for whom ivabradine was initiated during hospitalization between January 2011 and January 2014. All patients were in sinus rhythm and had a heart rate (HR) >70 bpm. Catecholamine use was necessary in 16 patients (57.1%) during the hospitalization, in 14 (87.5%) of these before ivabradine treatment.


RESULTS
Systolic blood pressure showed no variation during the first 24 h of ivabradine administration or at discharge. HR showed an absolute reduction of 10 bpm at 6 h (p < 0.001), 11 bpm at 24 h (p = 0.004) and 19 bpm (p < 0.001) at discharge. No episodes of significant bradycardia or hypotension were recorded after starting the drug.


CONCLUSIONS
HR reduction with ivabradine in acute HF is well tolerated. It represents an attractive option, especially when there is excessive catecholamine-related tachycardia; this should be appropriately evaluated in randomized trials.
Cardiology Department, University of Alcala de Henares, Hospital Ramx00F3;n y Cajal, Madrid, Spain.
Marina
M
Pascual Izco
Gonzalo Luis
GL
Alonso Salinas
Marcelo
M
Sanmartín Fernández
Hugo
H
Del Castillo Carnevalli
Manuel
M
Jiménez Mena
Asunción
A
Camino López
José Luis
JL
Zamorano Gómez
D000208:Acute Disease; D000368:Aged; D001552:Benzazepines / Q000627:therapeutic use*; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate; D006760:Hospitalization; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine