Efficacy of <i>I</i>_f Inhibition with Ivabradine in Different Subpopulations with Stable Angina Pectoris

Abstract

Objectives: The antianginal and anti-ischemic efficacy of ivabradine has been demonstrated in large-scale trials. Pooling trial data allowed for subpopulation analyses of ivabradine’s antianginal efficacy. Methods: Data on the frequency of angina attacks, short-acting nitrate consumption, and heart rate were pooled from 5 randomized trials in patients with stable angina pectoris receiving 5, 7.5, or 10 mg of ivabradine b.i.d. for 3 or 4 months. The subpopulations were defined according to age, sex, disease characteristics, and comorbidities (severity of angina, history of myocardial infarction, cerebrovascular disease, revascularization status, diabetes, asthma/chronic obstructive pulmonary disease, or peripheral vascular disease). Results: Efficacy data were available for 2,425 patients (full analysis set), in whom ivabradine reduced the frequency of diary-based angina attacks by 59.4% and nitrate consumption by 53.7%. All subpopulations experienced 51–70% reductions in the frequency of angina attacks, with similar reductions for the other parameters studied. Ivabradine’s efficacy was maintained in the presence of different comorbidities. In the safety set, ivabradine reduced heart rate by 14.5%. Ivabradine had a good safety and tolerability profile in all the subpopulations assessed. Conclusions: The antianginal efficacy of ivabradine was consistent across all the subpopulations analyzed, independent of the severity of angina and the presence of a comorbidity.

Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies

“…Aged patients remain challenging to treat because of a higher prevalence of comorbidities and more frequent side effects or intolerance to drugs [24]. Reduction in angina attacks and consumption of short-acting nitrates has been previously shown in a subgroup of 91 elderly patients with stable angina in a pooled analysis of RCTs [16]. Here, we demonstrated the antianginal effectiveness of ivabradine in a sizeable population of more than 1,600 patients ≥75 years seen in real clinical practice.…”

“…Compared with pooled randomized trials with ivabradine [16], the patients in our study were older (≥75 years: 19 vs. 4%) and more often women (41 vs. 18%). They also presented with a higher heart rate at baseline (83.3 vs. 73.0 bpm) and more hypertension (91 vs. 59%), dyslipidemia (80 vs. 53%), diabetes (46 vs. 19%), and asthma/COPD (35 vs. 6%).…”

“…Moreover, the antianginal efficacy of ivabradine has been established across a variety of subpopulations with diverse comorbidities, as demonstrated by a pooled analysis of five RCTs [16]. However, patients seen in clinical practice often differ from those included in RCTs and may not respond similarly to treatment.…”

Ivabradine in practice

“…16,17 The analysis of pooled data from ivabradine angina development programme assessing the antianginal efficacy of ivabradine is similar across several different subgroups of patients with stable angina selected on the basis of pretherapy characteristics or co-morbidities. 18 These results provide clinical evidence that ivabradine diminishes or prevents angina in all types of patients, independent of their baseline characteristics including age, sex, severity of angina, and revascularization status, as well as other features such as previous myocardial infarction, peripheral vascular disease, or diabetes. A reduction in HR of 11 b.p.m.…”

Lowering Heart Rate Post Revascularization

“…9 Several studies have shown ivabradine to be noninferior to first-line antianginal agents, such as beta-blockers and calcium channel blockers, and superior to placebo. [10][11][12][13] Ivabradine has a class IIa (level of evidence B) indication for the symptomatic treatment of chronic stable angina in patients intolerant to or inadequately controlled by beta-blockers. 2 In this issue of Angiology, Zarifis et al 14 evaluated the potential antianginal effect of ivabradine when coadministered with beta-blockers in 926 patients with chronic stable angina and history of coronary revascularization (coronary artery bypass graft or percutaneous coronary intervention) in a time period of 4 months.…”