Safety and efficacy of off-label use of ivabradine in patients with acute heart failure

Abstract

BackgroundIvabradine is approved to improve exercise tolerance and quality of life in patients with chronic heart failure; its use in acute heart failure (AHF) has not previously been studied.MethodsForty adult patients admitted with AHF were randomized into two groups; Group 1 patients were prescribed beta-blockers (BBs) and Group 2 patients were prescribed ivabradine. Both groups were given optimum anti-failure treatment for AHF. All patients were assessed for heart rate (HR), 6-minute walk test (6MWT), New York Heart Association (NYHA) classification, and Minnesota Living With Heart Failure Questionnaire (MLWHFQ) before and after 1 month of therapy.ResultsBBs or ivabradine among optimum medical therapy for AHF resulted in a significant improvement in all the studied parameters (NYHA class; 6MWT distance; HR and Borg scale dyspnea/fatigue score before and after the walk). The MLWHFQ was significantly worse during the follow-up in both groups. At the end of follow-up, there was a comparable beneficial effect attributed to the significant HR reduction observed in both groups.ConclusionThe results of this pilot study demonstrated the safety of the early use of ivabradine alone versus BBs when tolerated in patients admitted with AHF (both acutely decompensated as well as de novo). Both groups achieved comparable reduction in HR with improvement in functional capacity and exercise tolerance.

Effect of Ivabradine on Left Ventricular Diastolic Function, Exercise Tolerance and Quality of Life in Patients With Heart Failure: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

“…Characteristics of the included studies on HFpEF are summarized in Table 1 [15][16][17], and those on HFrEF in Table 2 [18][19][20][21][22][23][24][25][26][27]. A total of 821 patients were enrolled in the 13 included RCTs with duration of follow-up ranging from 7 days to 6 months.…”

Ivabradine: A Potential Therapeutic for Children With Refractory SVT

“…Ivabradine has no effect on vascular resistance as well ( 12 , 14 , 15 ). To this end, as compared to β-blockers, ivabradine can be safely administered to patients with acute decompensated systolic heart failure by virtue of its neutral ionotropic effect ( 16 ). Nonetheless, further studies are definitely needed to approve the use of this medication among these patients.…”

Ivabradine in patients with heart failure: a systematic literature review

“…Most studies included patients with heart rate ≥70 bpm [ 18 , 21 , 22 , 27 , 30 , 34 , 37 , 41 , 48 ], ≥75 bpm [ 19 , 23 , 24 , 28 , 38 , 40 ], or ≥80 bpm [ 20 ], except Potapenko et al (2011) [ 29 ], in which patients with heart rate ≥60 bpm were included. The majority of the included studies analyzed patients with baseline LVEF ≤40% [ 17 , 20 , 22 , 26 , 28 , 29 , 32–34 , 49 ] or ≤35% [ 19 , 21 , 23 , 27 , 30 , 35 , 37 , 40 ]. The mean age of patients ranged from 42 years to 74 years [ 20 , 50 ].…”