title: Benefits of Heart Rate Slowing With Ivabradine in Patients With Systolic Heart Failure and Coronary Artery Disease.
abstract: Heart rate (HR) is a risk factor in patients with chronic systolic heart failure (HF) that, when reduced, provides outcome benefits. It is also a target for angina pectoris prevention and a risk marker in chronic coronary artery disease without HF. HR can be reduced by drugs; however, among those used clinically, only ivabradine reduces HR directly in the sinoatrial nodal cells without other known effects on the cardiovascular system. This review provides current information regarding the safety and efficacy of HR reduction with ivabradine in clinical studies involving >36,000 patients with chronic stable coronary artery disease and >6,500 patients with systolic HF. The largest trials, Morbidity-Mortality Evaluation of the IfInhibitor Ivabradine in Patients With Coronary Disease and Left Ventricular Dysfunction and Study Assessing the Morbidity-Mortality Benefits of the IfInhibitor Ivabradine in Patients With Coronary Artery Disease, showed no effect on outcomes. The Systolic Heart Failure Treatment With the IfInhibitor Ivabradine Trial, a randomized controlled trial in >6,500 patients with HF, revealed marked and significant HR-mediated reduction in cardiovascular mortality or HF hospitalizations while improving quality of life and left ventricular mechanical function after treatment with ivabradine. The adverse effects of ivabradine predominantly included bradycardia and atrial fibrillation (both uncommon) and ocular flashing scotomata (phosphenes) but otherwise were similar to placebo. In conclusion, ivabradine improves outcomes in patients with systolic HF; rates of overall adverse events are similar to placebo.
authors: Division of Cardiovascular Medicine, Howard Gilman Institute for Heart Valve Diseases and Schiavone Institute for Cardiovascular Translational Research, State University of New York, Downstate Medical Center, Brooklyn and New York, New York. Electronic address: Jsborer1@gmail.com.
authors: Jeffrey S
authors: JS
authors: Borer
authors: Department of Medicine, San Francisco School of Medicine, University of California, Fresno, California.
authors: Prakash C
authors: PC
authors: Deedwania
authors: Amgen Inc., Thousand Oaks, California.
authors: Jae B
authors: JB
authors: Kim
authors: Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany.
authors: Michael
authors: M
authors: Böhm
mesh_terms: D001552:Benzazepines / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology; D054143:Heart Failure, Systolic / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate; D006760:Hospitalization; D006801:Humans; D000077550:Ivabradine; D009026:Mortality; D011788:Quality of Life; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine