Efficacy and Safety of Ivabradine in Combination with Beta-Blockers in Patients with Stable Angina Pectoris: A Systematic Review and Meta-analysis

Abstract

Introduction: Beta-blockers are recommended by the European Society of Cardiology as firstline antianginal therapy for reducing heart rate (HR) and symptoms in patients with chronic coronary syndrome, despite a lack of data showing superiority to other antianginal agents. Most patients with angina pectoris require combination therapy to manage symptoms, with a second-line agent chosen to manage the predominant cardiovascular problem. Ivabradine, a selective sinus node I f channel inhibitor shown to reduce HR and protect against anginal symptoms, has previously demonstrated noninferior anti-ischaemic and antianginal efficacy to beta-blockers. Methods: This systematic review and metaanalysis assessed the efficacy and safety of ivabradine in patients with stable angina pectoris who remained symptomatic despite receiving beta-blockers. Keyword searches of PubMed, The Cochrane Central Library Register, ClinicalTrials.gov, The World Health Organization International Clinical Trials Registry Platform (ICTRP) and Google Scholar identified studies comparing ivabradine plus beta-blockers with placebo or other first-or second-line antianginal agents in patients with stable angina pectoris. No date limits or language restrictions were applied. Outcomes were evaluated after 1 and 4 months of treatment, including changes in HR, angina attacks, use of shortacting nitrates, quality of life and safety. Risk of bias was evaluated on the basis of recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Results: Seven relevant studies were identified (N = 6821). Ivabradine plus a beta-blocker consistently reduced HR, anginal symptoms and short-acting nitrate consumption within 1 month of initiating therapy, with continued reductions for up to 4 months. Furthermore, ivabradine plus beta-blocker therapy was well tolerated, with bradycardia rarely reported (0.1% of patients overall). This study is limited by the inclusion of only two randomised studies, which may lead to result interpretation bias. Conclusions: Ivabradine may be valuable for tailoring early antianginal treatment when used in combination with beta-blockers for chronic

A proposed tree-based explainable artificial intelligence approach for the prediction of angina pectoris

“…It occurs when there is an increased demand for oxygen at the cellular level in the heart or a decrease in the oxygen concentration within the myocardium. While the narrowing of coronary arteries is commonly associated with decreased oxygen supply, other factors such as increased heart rate, untreated hypertension (high blood pressure), and heightened myocardial contractility can also contribute to AP 6 – 8 . Women may have less obstructive coronary artery disease and better left ventricular function than men.…”

Effect of Ivabradine in Controlling Heart Rate in Patients with Sepsis and Septic Shock: Randomized Control Trails

“…The drug inhibits the pacemaker If current in a dose-dependent manner at concentrations that do not interfere with other cardiac ion currents. When this channel is inhibited, cardiac pacemaker activity is reduced, lowering the heart rate and thus allowing more time for blood to flow to the heart muscle [16]. The major adverse effects of ivabradine include luminous phenomena, atrioventricular block, ventricular extra-systole and bradycardia [17].…”