title: Effect of early treatment with ivabradine combined with beta-blockers versus beta-blockers alone in patients hospitalised with heart failure and reduced left ventricular ejection fraction (ETHIC-AHF): A randomised study.
abstract: OBJECTIVE
  To analyse the effect of the early coadministration of ivabradine and beta-blockers (intervention group) versus beta-blockers alone (control group) in patients hospitalised with heart failure and reduced left ventricular ejection fraction (HFrEF).
  
  
  METHODS
  A comparative, randomised study was performed to compare the treatment strategies of beta-blockers alone versus ivabradine and beta-blockers starting 24hours after hospital admission, for acute HF in patients with an left ventricular ejection fraction (EF)<40%, sinus rhythm, and a heart rate (HR)>70bpm.
  
  
  RESULTS
  A total of 71 patients were examined, 33 in the intervention group and 38 in the control group. No differences were observed with respect to their baseline characteristics or standard treatment at discharge. HR at 28days (64.3±7.5 vs. 70.3±9.3bpm, p=0.01) and at 4months (60.6±7.5 vs. 67.8±8bpm, p=0.004) after discharge were significantly lower in the intervention group. Significant differences were found with respect to the EF and brain natriuretic peptide levels at 4months. No differences in clinical events (rehospitalisation/death) were reported at 4months. No severe side effects attributable to the early administration of ivabradine were observed.
  
  
  CONCLUSIONS
  The early coadministration of ivabradine and beta-blockers during hospital admission for acute HFrEF is feasible and safe, and it produces a significant decrease in HR at 28days and at 4months after hospital discharge. It also seemed to improve systolic function and functional and clinical parameters of HF patients at short-term.
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain. Electronic address: fjhl.87@gmail.com.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Hidalgo
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Castillo
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Pardo
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Durán
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: José J
authors.initials: JJ
authors.lastname: Sánchez
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferreiro
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Mesa
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Delgado
authors.affiliation: Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Martín
authors.initials: M
authors.lastname: Ruiz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D001552:Benzazepines / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D001552:Benzazepines; D000077550:Ivabradine
keywords: Beta-blocker; Heart failure; Heart rate; Ivabradine